Healthcare Advocate - Remote

$70,200 - $137,800/Yr

UnitedHealth Group - Toms River, NJ

Full-time - Entry Level

Remote - Toms River, NJ

Insurance Carriers and Related Activities

About the position

The Healthcare Advocate position at UnitedHealth Group involves working remotely to improve health outcomes for Medicare Advantage Members by connecting them with necessary care and resources. The role requires independent travel across New Jersey and New York to meet with healthcare providers, establish relationships, and provide training on coding and documentation practices. The position emphasizes the importance of accurate coding and documentation to ensure proper reimbursement and compliance with CMS standards.

Responsibilities

• Travel across assigned territory to meet with providers and discuss Optum tools and programs.
• Utilize data analysis to identify and target providers for coding and documentation training.
• Establish positive, long-term relationships with physicians, medical groups, IPAs, and hospitals.
• Develop provider-specific plans to enhance RAF performance and coding specificity.
• Manage end-to-end Risk and Quality Client Programs, ensuring accurate data delivery and payments.
• Consult with provider groups on documentation and coding gaps.
• Provide feedback on EMR/EHR systems regarding CMS documentation standards.
• Collaborate with a multi-disciplinary team to implement programs directed by Market Consultation leadership.
• Assist providers in understanding Medicare quality programs and CMS-HCC Risk Adjustment payment methodologies.
• Provide ICD-10 coding training to providers and office staff as needed.
• Develop and present coding training to clinicians and practice managers.
• Deliver diagnosis coding tools to providers and train staff on documentation and billing practices.
• Provide actionable solutions to improve documentation and coding accuracy.
• Collaborate with various personnel on Risk Adjustment and Quality education efforts.
• Assist in collecting charts for analysis.

Requirements

• 1+ years of experience in the Healthcare industry.
• Experience in Risk Adjustment and/or HEDIS/Stars.
• Knowledge of ICD10 coding guidelines.
• Proficient in MS Office Tools (Excel, PowerPoint, Word).
• Ability to work with common office software, coding software, EMR, and abstracting systems.
• Valid Driver's License and current Auto Insurance.
• Must live in NY or NJ for regional travel requirements.
• Willingness to travel approximately 75% of the time in regional areas.

Nice-to-haves

• Certified Professional Coder / CPC-A or equivalent certifications.
• CRC certification.
• 4+ years of clinic or hospital experience and/or managed care experience.
• 1+ years of coding experience at a healthcare facility.
• Management experience in a physician practice.
• Nursing background (LPN, RN, NP).
• Knowledge of EMR for recording patient visits.
• Knowledge of billing/claims submission processes.

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution