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)
*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.
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.
