Healthcare Advocate | Birmingham, Alabama

Healthcare AdvocateOptum Insight is improving the flow of health data and information to create a more connected system. We remove friction and drive alignment between care providers and payers, and ultimately consumers. Our deep expertise in the industry and innovative technology empower us to help organizations reduce costs while improving risk management, quality and revenue growth. Ready to help us deliver results that improve lives? Join us to start Caring. Connecting. Growing together.
The Healthcare Advocate serves as a strategic partner to physicians, medical groups, IPAs, and hospitals, supporting accurate documentation and coding practices to ensure a complete and accurate health picture of members across government and regulated lines of business, including Medicare Advantage, Medicaid, and ACA. This role focuses on improving quality of care, closing gaps in care, and driving performance in Risk Adjustment and Quality programs through education, collaboration, and data-driven strategies.
If you reside in the state of Alabama, you will have the flexibility to work remotely
* as you take on some tough challenges.
Primary

Responsibilities:
Act as a trusted advisor and strategic partner to providers and medical groups, assisting in accurate documentation and coding to reflect members' true health statusTravel independently across the assigned territory (approximately 80% field-based, with occasional overnight travel) to engage providers in Optum tools and programs that enhance quality of care for Medicare Advantage membersGaining participation and deployment of Prospective Programs achieving business goals and metricsUtilize data analysis to identify and target providers who would benefit from coding, documentation, and quality training resourcesEstablish positive, long-term, consultative relationships with physicians, medical groups, IPAs and HospitalsDevelop and implement comprehensive, provider-specific plans to improve RAF performance, coding specificity, and gap closureManage end-to-end Risk Adjustment and Quality programs, including In-Office Assessment initiativesConsult with provider groups on documentation and coding gaps; provide actionable feedback to improve compliance with CMS standardsOffer guidance on EMR/EHR system issues impacting documentation and coding accuracyCollaborate with multidisciplinary teams to implement prospective programs as directed by leadershipEducate providers on Medicare quality programs and CMS-HCC Risk Adjustment methodology, emphasizing the importance of accurate chart documentation for proper reimbursementSupport providers in ensuring documentation aligns with ICD-10 and CPT II coding guidelines and national standardsDeliver ICD-10 HCC coding training and develop tools for providers and office staffProvide measurable, actionable solutions to improve documentation and coding accuracyPartner with physicians, coders, and facility staff on Risk Adjustment and Quality education effortsAssist in chart collection and analysis as neededYou'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required

Qualifications:
2+ years of healthcare experience with solid knowledge of medical terminology and clinical issues1+ years of experience in a physician office, clinic, hospital, or similar medical setting1+ years of experience with EMR systemsProficiency in MS Office (Excel, Word, PowerPoint) with ability to manipulate data, create documents, and deliver presentationsSelf-driven, goal-oriented, and able to work independently while prioritizing tasks and meeting deadlinesDemonstrated solid communication skills with ability to engage multiple stakeholders and collaborate across teamsAbility to travel up to 75
- 80% within designated market; reliable personal transportationPreferred

Qualifications:
Certified Professional Coder (CPC/CPC-A) or equivalent certificationCRC certification2+ years of clinic/hospital or managed care experienceExperience in Risk Adjustment, HEDIS/Stars, and gap closure initiativesExperience in provider network management, physician contracting, healthcare consulting, Medicare Advantage sales, or pharmaceutical salesProject management experienceTerritory management experienceKnowledge of billing, claims submission, and coding softwareNursing background (LPN, RN, NP)Advanced proficiency in MS Excel (pivot tables, advanced functions)*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter PolicyPay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary,

we offer
benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements)