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OptumInsight
Morgantown, WV, United States (on-site)
14 days ago
OptumInsight
Morgantown, West Virginia, United States (on-site)
14 days ago

Description

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Come make an impact on the communities we serve as we help advance health equity on a global scale. Here, you will find talented peers, comprehensive benefits, a culture guided by diversity and inclusion, career growth opportunities and your life's best work.(sm)

The Practice Consultant is responsible for program implementation and provider performance management which is tracked by designated provider metrics, inclusive minimally of 4 STAR gap closure and coding accuracy demonstrating full assessment and suspect closure. The person in this role is expected to work directly with care providers to build relationships, ensure effective education and reporting, proactively identify performance improvement opportunities through analysis and discussion with subject matter experts; and influence provider behavior to achieve needed results. The person will review charts (paper and electronic - EMR), identify gaps in care and open suspect opportunities, and educate providers and offices to ensure they are coding to the highest specificity for both risk adjustment and quality reporting. Work is primarily performed at physician practices on a daily basis.

If you are located in Morgantown, WV, you will have the flexibility to work remotely*, as well as work in the office as you take on some tough challenges. This is a field based position. When not out in the field traveling, you will work from home. Must be able to cover assigned travel territory in and around Morgantown, WV.

Primary Responsibilities:
  • Functioning independently, travel across assigned territory to meet with providers to discuss UHC and Optum tools and UHC incentive programs for both risk adjustment and quality reporting, focused on improving the quality of care for Medicare Advantage Members
  • Establish positive, long-term, consultative relationships with physicians, medical groups, IPAs and ACOs
  • Develop comprehensive, provider-specific plans to increase their HEDIS performance, facilitate risk adjustment suspect closure and improve their outcomes
  • Access PCOR to identify risk adjustment opportunities and utilize other available reporting sources including but not limited to (InSite, Spotlight, Doc360, Provider Scorecard, CPT II Report) to analyze data and prioritize gap and suspect closure, identify trends and drive educational opportunities
  • Conduct chart review quarterly and provide timely feedback to provider to improve reporting on a go forward basis
  • Conduct additional chart reviews such as a quarterly post-visit ACV review and various focused progress notes reviews with provider feedback to improve documentation and coding resulting in improved gap and suspect closure
  • Coordinates and provides ongoing strategic recommendations, training and coaching to provider groups on program implementation and barrier resolution
  • Training will include Stars measures (HEDIS/CAHPS/HOS/medication adherence), coding for quality care (CPT II) and exclusions (ICD-10-CM), risk adjustment coding practices (ICD-10-CM), and Optum program administration including use of plan tools, reports and systems
  • Lead regular Stars and risk adjustment specific JOC meetings with provider groups to drive continual process improvement and achieve goals
  • Provide reporting to health plan leadership on progress of overall performance, MAPCPi, MCAIP, gap closure, and use of virtual administrative resources
  • Facilitate/lead monthly or quarterly meetings, as required by plan leader, including report and material preparation
  • Collaborates and communicates with the member’s health care and service with our interdisciplinary delivery team to coordinate the care needs for the member
  • Partner with providers to engage in UnitedHealthcare member programs such as HouseCalls, clinic days, Navigate4Me
  • Includes up to 75% local travel

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:
  • 5+ years of healthcare industry experience
  • 1+ years of provider facing experience
  • Microsoft Office experience including Excel with exceptional analytical and data representation expertise
  • Solid knowledge of Medicare Advantage including Stars and Risk Adjustment
  • Knowledge of ICD-10-CM and CPT II coding
  • Certified Risk Adjustment Coder or Certified Professional Coder with AAPC with the requirement to obtain both certifications, CRC and CPC, within first year in position (CRC within 6 months of hire and CPC within 1 year of hire)


Preferred Qualifications:
  • Bachelor’s degree (preferably in Healthcare or relevant field)
  • Registered Nurse
  • Experience working for a health plan and/or within a provider office
  • Experience with network and provider relations/contracting
  • Experience retrieving data from EMRs (electronic medical records)
  • Experience in management or coding position in a provider primary care practice
  • Knowledge base of clinical standards of care, preventive health, and Stars measures
  • Demonstrate a level of knowledge, skill and understanding of ICD-10-CM and CPT coding principles consistent with certification by AAPC
  • Knowledge of billing or claims submission and other related actions
  • Solid communication and presentation skills
  • Solid problem-solving skills
  • Good work ethic, desire to succeed, self-starter
  • Ability to deliver training materials designed to improve provider compliance
  • Ability to use independent judgment, and to manage and impart confidential information
  • Solid relationship building skills with clinical and non-clinical personnel
  • Excellent oral & written communication skills


Careers with Optum. Our objective is to make health care simpler and more effective for everyone. With our hands at work across all aspects of health, you can play a role in creating a healthier world, one insight, one connection and one person at a time. We bring together some of the greatest minds and ideas to take health care to its fullest potential, promoting health equity and accessibility. Work with diverse, engaged and high-performing teams to help solve important challenges.

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

Job Information

  • Job ID: 67791707
  • Workplace Type: On-Site
  • Location:
    Morgantown, West Virginia, United States
  • Company Name For Job: OptumInsight
  • Position Title: Practice Performance Manager / Medicare Consultant - Field Based in WV
  • Industry: Other
  • Job Function: Any
  • Job Type: Full-Time

Please refer to the company's website or job descriptions to learn more about them.

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