Practice Performance/Medicare Consultant Job at Optum
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. Come make an impact on the communities we serve as we help advance health equity on a global scale. Here, you will find talented peers, comprehensive benefits, a culture guided by diversity and inclusion, career growth opportunities and
your life's best work.(sm)
If you are located in or near Panama City, FL, you will have the flexibility to work remotely* as you take on some tough challenges. This is a field based position. When not out in the field traveling, you will work from home. Must be able to cover assigned travel territory in and around the Panama City, FL area.
Primary Responsibilities:
Required Qualifications:
*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy
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.
Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
XJ6
If you are located in or near Panama City, FL, you will have the flexibility to work remotely* as you take on some tough challenges. This is a field based position. When not out in the field traveling, you will work from home. Must be able to cover assigned travel territory in and around the Panama City, FL area.
Primary Responsibilities:
- Functioning independently, travel across assigned territory to meet with providers to discuss UHC and Optum tools and UHC incentive programs for both risk adjustment and quality reporting, focused on improving the quality of care for Medicare Advantage Members
- Establish positive, long-term, consultative relationships with physicians, medical groups, IPAs and ACOs
- Develop comprehensive, provider-specific plans to increase their HEDIS performance, facilitate risk adjustment suspect closure and improve their outcomes
- Access PCOR to identify risk adjustment opportunities and utilize other available reporting sources including but not limited to (InSite, Spotlight, Doc360, Provider Scorecard, CPT II Report) to analyze data and prioritize gap and suspect closure, identify trends and drive educational opportunities
- Conduct chart review quarterly and provide timely feedback to provider to improve reporting on a go forward basis
- Conduct additional chart reviews such as a quarterly post-visit ACV review and various focused progress notes reviews with provider feedback to improve documentation and coding resulting in improved gap and suspect closure
- Coordinates and provides ongoing strategic recommendations, training and coaching to provider groups on program implementation and barrier resolution
- Training will include Stars measures (HEDIS/CAHPS/HOS/medication adherence), coding for quality care (CPT II) and exclusions (ICD-10-CM), risk adjustment coding practices (ICD-10-CM), and Optum program administration including use of plan tools, reports and systems
- Lead regular Stars and risk adjustment specific JOC meetings with provider groups to drive continual process improvement and achieve goals
- Provide reporting to health plan leadership on progress of overall performance, MAPCPi, MCAIP, gap closure, and use of virtual administrative resources
- Facilitate/lead monthly or quarterly meetings, as required by plan leader, including report and material preparation
- Collaborates and communicates with the member’s health care and service with our interdisciplinary delivery team to coordinate the care needs for the member
- Partner with providers to engage in UnitedHealthcare member programs such as HouseCalls, clinic days, Navigate4Me
- Includes up to 75% local travel
Required Qualifications:
- Certified Risk Adjustment Coder (CRC via AAPC) or either: Certified Professional Coder (CPC via AAPC) or Certified Coding Specialist – Physician-based (CCS-P via AHIMA); with the requirement to obtain both certifications within first year in position (CRC within 6 months of hire and CPC within 1 year of hire, if not currently CPC or CCS-P)
- 5+ years of healthcare industry experience
- 1+ years of provider facing experience
- Microsoft Office experience including Excel with exceptional analytical and data representation expertise
- Solid knowledge of Medicare Advantage including Stars and Risk Adjustment
- Knowledge of ICD-10-CM and CPT II coding
- 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. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation
- Bachelor’s degree (preferably in Healthcare or relevant field)
- Registered Nurse
- Experience working for a health plan and/or within a provider office
- Experience with network and provider relations/contracting
- Experience retrieving data from EMRs (electronic medical records)
- Experience in management or coding position in a provider primary care practice
- Demonstrate a level of knowledge, skill and understanding of ICD-10-CM and CPT coding principles consistent with certification by AAPC or AHIMA
- Knowledge base of clinical standards of care, preventive health, and Stars measures
- Knowledge of billing or claims submission and other related actions
- Ability to deliver training materials designed to improve provider compliance
- Good work ethic, desire to succeed, self-starter
- Ability to use independent judgment, and to manage and impart confidential information
- Solid communication and presentation skills
- Solid problem-solving skills
- Excellent oral & written communication skills
- Solid relationship building skills with clinical and non-clinical personnel
*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy
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.
Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
XJ6
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