Healthcare Advocate - Field Position

Requisition Number: 2388859
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 in making healthcare work better for everyone through people-led, responsible AI while Caring. Connecting. Growing together.
The Healthcare Advocate is responsible for a range of provider relations services within Optum. The 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 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.
NOTE: Qualified candidates must live in the Northern New Jersey regional area to perform the daily field-based expectations of this position.
If you are located in Jersey City, NJ, 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 <250 members
• 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:

• 3+ years of healthcare experience with demonstrated knowledge of medical terminology and clinical issues
• 1+ years of experience with EMR systems
• Demonstrated experience using MS Office (Excel, Word, PowerPoint) with ability to manipulate data, create documents, and deliver presentations
• Demonstrated knowledge of ICD-10, HEDIS, and Stars programs
• Demonstrated ability to identify automation opportunities and leverage AI to improve productivity and quality
• Demonstrated ability to communicate, engage, and develop relationships across diverse audiences and collaborating teams (i.e., providers and internal stakeholders)
• Demonstrated ability/willingness to travel approximately 75% of the time in the assigned territory (Northern NJ Regional Area) as business needs dictate
• Live within the Northern NJ Regional Area to perform daily travel requirements
• Reliable personal transportation to perform daily travel requirements
• Must have proof of valid Driver's License and current auto insurance

Preferred Qualifications:

• Certified Professional Coder (CPC/CPC-A) or equivalent certification
• CRC certification
• 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
• Experience in provider network management, physician contracting, healthcare consulting, Medicare Advantage sales, or pharmaceutical sales
• Project management experience
• Territory management experience
• Demonstrated knowledge of billing, claims submission, and coding software
• Nursing 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 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 $72,800 - $130,000 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 help make the health system work better for everyone. Together, we are shaping the future of healthcare by harnessing technology and innovation to make care simpler to navigate, more affordable and more connected for the people we serve. We are committed to creating an inclusive workplace where everyone feels welcomed, valued, heard and respected, empowering people to bring their authentic selves to work and strengthening our collective impact through diverse talents, backgrounds, experiences and perspectives.
UnitedHealth Group and its affiliated brands are 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 and its affiliated brands are a drug-free workplace. Candidates are required to pass a drug test before beginning employment.