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)

You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Functioning independently with outreach to providers to discuss Optum tools and programs focused on improving the quality of care for Medicare Advantage Members, Medicaid and ACA Members
• Utilizing data analysis, identify and target providers who would benefit from our coding, documentation and quality training and resources
• Inbound and outbound calling to connect virtually in order to establish positive, long-term, consultative relationships with physicians, medical groups, IPAs and hospitals
• 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
• 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
• Delivers diagnosis coding tools to providers
• 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
  

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:

• High school diploma/GED or above
• 2+ years of experience within the Healthcare Field
• Understanding of Medicare Advantage, Medicaid and ACA programs
• Proficient in MS Office (Excel (Pivot tables, excel functions), PowerPoint and Word)
• Ability to identify confidentiality and its requirements (HIPAA)

Preferred Qualifications:

• 2+ years of Customer Service Representative (CSR) experience OR 1+ years of experience in an office setting or call center setting
• Experience with medical terminology
• Knowledge of ICD10, HEDIS and Stars
• Knowledge of CMS-HCC Risk Adjustment
• Knowledge of provider office workflow
• Ability to work independently toward individual and team metrics
• Ability to interact and verbally communicate effectively with provider offices and all levels of personnel in a professional, courteous, and effective manner with excellent customer service skills
• Demonstrated organizational and prioritization 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.

Colorado, Connecticut, Nevada, or New York City Residents Only: The hourly range for Colorado residents is $21.68 to $38.56. The hourly range for Connecticut/Nevada/New York City residents is $23.94 to $42.40. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

*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.