Healthcare Advocate Optum Insight is improving the flow of health data and information to create a more connected system. We remove friction and drive alignment between care providers and payers, and ultimately consumers. Our deep expertise in the industry and innovative technology empower us to help organizations reduce costs while improving risk management, quality and revenue growth. Ready to help us deliver results that improve lives? Join us to start Caring. Connecting. Growing together. 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. This is a field-based position covering travel territory based in Maryland and District of Columbia. Qualified candidates must reside in the Maryland/DC regional area to be considered.
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
- Responsible for 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
Demonstrated communication skills with ability to engage multiple stakeholders and collaborate across teams
Self-driven, goal-oriented, and able to work independently while prioritizing tasks and meeting deadlines
Required Qualifications:- 3+ years of healthcare experience with solid knowledge of medical terminology and clinical issues 2+ years of experience with EMR systems
- Experience in a physician office, clinic, hospital, or similar medical setting
- Demonstrated knowledge of ICD-10, HEDIS, and Stars programs
- Demonstrated proficiency in MS Office (Excel, Word, PowerPoint) with ability to manipulate data, create documents, and deliver presentations
- Reside in the Maryland / Washington DC Regional Area to perform daily field travel requirements
- Must be able/willing to travel approximately 80% of the time, this is a field-based position that required daily local state travel
- Must have proof of a valid Driver's License, reliable transportation, and current auto insurance to perform daily local state travel
Preferred Qualifications:- Certified Professional Coder (CPC/CPC-A) or equivalent certificationCRC certification 2+ years of clinic/hospital or managed care experience
- Experience in nursing (LPN, RN, NP)
- Demonstrates advanced proficiency in MS Excel (pivot tables, advanced functions)
- Experience in Risk Adjustment, HEDIS/Stars, and gap closure initiatives
- Demonstrated knowledge of billing claims submission, and coding software
- Project management experience
- Previous experience in provider network management, physician contracting, healthcare consulting, or Medicare Advantage sales
- Territory management experience
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). 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.
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.
UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.
