Healthcare Advocate

3 weeks ago

New York, New York, United States UnitedHealth Group Full time

As a Telecommute Healthcare Advocate with UnitedHealth Group, you will have the opportunity to work independently and travel across assigned territory to meet with providers and discuss Optum tools and programs focused on improving the quality of care for Medicare Advantage Members.


Key Responsibilities:
  • Functioning independently, travel across assigned territory to meet with providers to discuss Optum tools and programs focused on improving the quality of care for Medicare Advantage Members.
  • Utilizing data analysis, identify and target providers who would benefit from our coding, documentation and quality training and resources.
  • Establish positive, long-term, consultative relationships with physicians, medical groups, IPAs and hospitals.
  • Develop comprehensive, provider-specific plans to increase their RAF performance and improve their coding specificity.
  • Manage end-to-end Risk and Quality Client Programs such as Healthcare Patient Assessment Form on ensuring correct delivery of data/forms to the correct providers, and the return of the data to coding ops, ensuring accurate payments are occurring for each provider based on client contract.
  • Consult with provider groups on gaps in documentation and coding.
  • Provide feedback on EMR/EHR systems where it is causing issues in meeting CMS standards of documentation and coding.
  • Partner with a multi-disciplinary team to implement prospective programs as directed by Market Consultation leadership.
  • Assists providers in understanding the Medicare quality program as well as CMS-HCC Risk Adjustment program as it relates to payment methodology and the importance of proper chart documentation of procedures and diagnosis coding.
  • Assist providers in understanding quality and CMS-HCC Risk Adjustment driven payment methodology and the importance of proper chart documentation of procedures and diagnosis coding.
  • Supports the providers by ensuring documentation supports the submission of relevant ICD-10 codes and CPT2 procedural information in accordance with national coding guidelines and appropriate reimbursement requirements.
  • Provides ICD-10-HCC coding training to providers and appropriate office staff as needed.
  • Develops and presents coding presentations and training to large and small groups of clinicians, practice managers and certified coders developing training to fit specific provider's needs.
  • Develops and delivers diagnosis coding tools to providers.
  • Trains physicians and other staff regarding documentation, billing and coding and provides feedback to physicians regarding documentation practices.
  • Provides measurable, actionable solutions to providers that will result in improved accuracy for documentation and coding practices.
  • Collaborates with doctors, coders, facility staff and a variety of internal and external personnel on a wide scope of Risk Adjustment and Quality education efforts.
  • Assist in collecting charts where necessary for analysis.

Requirements:
  • Bachelor's degree (preferably in Healthcare or related field) or equivalent work experience.
  • Proficiency in MS Office (Excel (Pivot tables, excel functions), PowerPoint and Word).
  • Must be able to work effectively with common office software, coding software, EMR and abstracting systems.
  • Ability to communicate and present to multiple stakeholders using various types of media.
  • Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others.
  • Proven ability to effectively engage, manage and maintain relationships with physicians/hospitals/health systems/clinical and non-clinical personnel.
  • Ability to travel within state up to 75% of the time to client locations.
  • Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements.

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