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Job description
Requisition number:
Job category: Network Management
Optum 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 Associate Healthcare Advocate is responsible for a range of provider relations services within Optum. The Associate Healthcare Advocate will work as an extension of the local Provider Performance Team by aligning to geographical regions, medical centers and/or physician practices that manage a high volume of membership. The Associate Healthcare Advocate under the supervision of a Director/ Manager and or Mentor is responsible for the successful program implementation, compliance with network requirements, network assessment and selection, and program/product implementation.
If you are located in Bronx, NY, you will have the flexibility to work remotely* as you take on some tough challenges.
Primary Responsibilities:
Manage provider groups in a defined market, limited to groups with Locate medical screening results/documentation to ensure the closure of gaps in care/suspect medical conditions. Will not conduct any evaluation or interpretation of Clinical data and will be supervised by licensed and/or certified staff
Activities may include data collection, data entry, quality monitoring, HQPAF submission and chart collection activities
Partner with your leadership team, the practice administrative or clinical staff to determine best strategies to support the practice and our 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
Provide measurable, actionable solutions to improve documentation and coding accuracy.
Anticipate customer needs and proactively develop solutions to meet them
Optimize customer satisfaction, positively impact the closing of gaps in care and productivity
Manage time effectively to ensure productivity goals are met
Ability to problem solve, use best professional judgment and apply critical thinking techniques to resolve issues as they arise Adhere to corporate requirements related to industry regulations/responsibilities
Maintain confidentiality and adhere to HIPAA requirements
Function independently, meeting with physicians to discuss OPTUM tools and programs focused on improving the quality of care for Medicare & Medicaid Advantage Members
Educate providers on Medicare quality programs and CMS-HCC Risk Adjustment methodology, emphasizing the importance of accurate chart documentation for proper reimbursement
Support providers in ensuring documentation aligns with ICD-10 and CPT II coding guidelines and national standards
Ability to travel within assigned territory (day trips) 75% of the time
Other duties, as assigned
You'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 demonstrated knowledge of medical terminology and clinical issues
1+ years of experience with EMR systems
Demonstrated knowledge of ICD-10, HEDIS, and Stars programs
Demonstrated experience using MS Office (Excel, Word, PowerPoint) with ability to manipulate data, create documents, and deliver presentations
Demonstrated ability to communicate, engage, and develop relationships across diverse audiences and collaborating teams (i.e., providers and internal stakeholders)
Must be able/willing to travel approximately 75% of the time in the assigned territory (Bronx NY Regional Area) as business needs dictate
Reside within the Bronx NY Regional Area to perform daily travel requirements
Access to reliable personal transportation to perform daily travel requirements
Valid Driver's License and current auto insurance
Preferred Qualifications:
Certified Professional Coder (CPC/CPC-A) or equivalent certification.
CRC certification
Nursing background (LPN, RN, NP)
2+ years of managed care experience
Experience in a physician office, clinic, hospital, or similar medical setting
Experience in Risk Adjustment, HEDIS/Stars, and gap closure initiatives
Advanced proficiency in MS Excel (pivot tables, advanced functions)
Demonstrated knowledge of billing, claims submission, and coding software
Project management experience
Experience in provider network management, physician contracting, healthcare consulting, Medicare Advantage sales, or pharmaceutical sales
Territory management experience
#OptumInsightPJ
*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
Pay 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). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $60,200 - $107,400 annually based on full-time employment. We comply with all minimum wage laws as applicable.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.
UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.
Worksite address
bronx, NY, 10400, US
Who can apply
Review the original listing for work authorization, qualifications and employer requirements.