Healthcare Advocate

4 weeks ago

Miramar, Florida, United States Optum Full time

Optum Healthcare Professional

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes.

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.
  • 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.
  • Assist 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.
  • 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 ICD10-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:

  • 2+ years of a healthcare background with medical terminology, familiarity of clinical issues.
  • 1+ years of experience with Hospital or provider office EMR.
  • Experience working in a physician office, clinic, hospital, or other medical setting.
  • Intermediate level of knowledge of ICD10, HEDIS or Stars.
  • Intermediate level of proficiency in MS Office Excel, ability to manipulate data, filter.
  • Intermediate level of proficiency in MS Office Word, ability to create, edit and save documents.
  • Intermediate level of proficiency in MS Office PowerPoint, ability to create and present presentations.
  • Fluent in Spanish & English.
  • Ability to travel up to 75% of the time in the lower Broward County to upper Miami-Dade County regional area (must live in this region to perform the daily travel expectations).
  • Active and unrestricted driver's license.
  • Personal reliable transportation.

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