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 < 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: - 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
*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.
