If you reside within Western, KY you will have the flexibility to telecommute* as you take on some tough challenges.

Primary Responsibilities:

Functioning independently, travel across assigned territory to meet with providers to discuss Optum tools and programs focused on improving the quality of care for Medicare Advantage Members. Will be out in the field 80% of time in defined territory with rare occasion of overnight travel

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

Develop comprehensive, provider-specific plans to increase their RAF performance and improve their coding specificity

Manage end-to-end Risk and Quality Client Programs such as Healthcare Patient Assessment Form on ensuring correct delivery of data/forms to the correct providers, and the return of the data to coding ops, ensuring accurate payments are occurring for each provider based on client contract

Consult with provider groups on gaps in documentation and coding

Provide feedback on EMR/EHR systems where it is causing issues in meeting CMS standards of documentation and coding

Partner with a multi-disciplinary team to implement prospective programs as directed by Market Consultation leadership

Assists providers in understanding the Medicare quality program as well as CMS-HCC Risk Adjustment program as it relates to payment methodology and the importance of proper chart documentation of procedures and diagnosis coding

Assist providers in understanding quality and CMS-HCC Risk Adjustment driven payment methodology and the importance of proper chart documentation of procedures and diagnosis coding

Supports the providers by ensuring documentation supports the submission of relevant ICD -10 codes and CPT2 procedural information in accordance with national coding guidelines and appropriate reimbursement requirements

Provides ICD10 - HCC coding training to providers and appropriate office staff as needed

Develops and presents coding presentations and training to large and small groups of clinicians, practice managers and certified coders developing training to fit specific provider's needs

Develops and delivers diagnosis coding tools to providers

Trains physicians and other staff regarding documentation, billing and coding and provides feedback to physicians regarding documentation practices

Provides measurable, actionable solutions to providers that will result in improved accuracy for documentation and coding practices

Collaborates with doctors, coders, facility staff and a variety of internal and external personnel on a wide scope of Risk Adjustment and Quality education efforts

Assist in collecting charts where necessary for analysis

This position requires travel up to 75% within the state. Relocation is not provided for this position.

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:

Bachelor's degree (preferably in Healthcare or related field) or equivalent work experience

Proficiency in MS Office (Excel (Pivot tables, excel functions), PowerPoint and Word)

Must be able to work effectively with common office software, coding software, EMR and abstracting systems

Ability to communicate and present to multiple stakeholders using various types of media

Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others

Proven ability to effectively engage, manage and maintain relationships with physicians/hospitals/health systems/clinical and non-clinical personnel

Ability to travel within state up to 75% of the time to client locations

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