Healthcare Advocate

Job description

Healthcare Advocate

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 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 status

Travel 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 members

Gaining participation and deployment of Prospective Programs achieving business goals and metrics

Utilize data analysis to identify and target providers who would benefit from coding, documentation, and quality training resources

Establish positive, long-term, consultative relationships with physicians, medical groups, IPAs and Hospitals

Develop and implement comprehensive, provider-specific plans to improve RAF performance, coding specificity, and gap closure

Manage end-to-end Risk Adjustment and Quality programs, including In-Office Assessment initiatives

Consult with provider groups on documentation and coding gaps; provide actionable feedback to improve compliance with CMS standards

Offer guidance on EMR/EHR system issues impacting documentation and coding accuracy

Collaborate with multidisciplinary teams to implement prospective programs as directed by leadership

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

Deliver ICD-10 HCC coding training and develop tools for providers and office staff

Provide measurable, actionable solutions to improve documentation and coding accuracy

Partner with physicians, coders, and facility staff on Risk Adjustment and Quality education efforts

Assist in chart collection and analysis as needed

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 solid knowledge of medical terminology and clinical issues

1+ years of experience in a physician office, clinic, hospital, or similar medical setting

1+ years of experience with EMR systems

Proficiency in MS Office (Excel, Word, PowerPoint) with ability to manipulate data, create documents, and deliver presentations

Self-driven, goal-oriented, and able to work independently while prioritizing tasks and meeting deadlines

Demonstrated solid communication skills with ability to engage multiple stakeholders and collaborate across teams

Ability to travel up to 75- 80% within designated market; reliable personal transportation

Preferred Qualifications:

Certified Professional Coder (CPC/CPC-A) or equivalent certification

CRC certification

2+ years of clinic/hospital or managed care experience

Experience in Risk Adjustment, HEDIS/Stars, and gap closure initiatives

Experience in provider network management, physician contracting, healthcare consulting, Medicare Advantage sales, or pharmaceutical sales

Project management experience

Territory management experience

Knowledge of billing, claims submission, and coding software

Nursing background (LPN, RN, NP)

Advanced proficiency in MS Excel (pivot tables, advanced functions)

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). The salary for this role will range from $72,800 - $130,000 annually based on full-time employment. We comply with all minimum wage laws as applicable.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. 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

birmingham, AL, 35275, US

Who can apply

Review the original listing for work authorization, qualifications and employer requirements.