Network Program Consultant - Remote

Requisition Number: 2378662
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. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.
If you are located in Nashville, TN, you will have the flexibility to work remotely* as you take on some tough challenges.
Primary Responsibilities:

• Functioning independently, travel across assigned territory to meet with providers to discuss Optum tools and programs focused on improving the quality of care for Medicare Advantage Members. Will be out in the field 75% of time in defined territory with rare occasion of overnight travel
• Utilizing data analysis, identify and target providers who would benefit from our coding, documentation and quality training and resources
• Establish positive, long-term, consultative relationships with physicians, medical groups, IPAs and hospitals
• Develop comprehensive, provider-specific plans to increase their RAF performance and improve their coding specificity
• Manage end-to-end Risk and Quality Client Programs
• 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
• Assists providers in understanding the Medicare quality program as well as CMS-HCC Risk Adjustment program as it relates to payment methodology and the importance of proper chart documentation of procedures and diagnosis coding
• 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
• Provides ICD10 - HCC coding training to providers and appropriate office staff as needed
• Develops and presents coding presentations and training to large and small groups of clinicians, practice managers and certified coders developing training to fit specific provider's needs
• Delivers diagnosis coding tools to providers
• Trains physicians and other staff regarding documentation, billing and coding and provides feedback to physicians regarding documentation practices
• 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
• Assist in collecting charts where necessary for analysis
• Self-starter with the ability to work independently and remain on task; ability to prioritize and meet deadlines
• Other duties, as assigned

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 a healthcare background with medical terminology, familiarity of clinical issues
• Intermediate level of proficiency in MS Office Excel, PowerPoint, Word with the ability to manipulate data, filter, create and present presentations
• Must be able/willing to travel up to 75% of the time in the assigned territory across Central South Tennessee
• Active, unrestricted driver's license and auto insurance
• Access to reliable personal transportation to perform daily travel requirements

Preferred Qualifications:

• Certified Professional Coder / CPC-A; equivalent certifications acceptable
• CRC certification
• 3+ years of provider network management, physician contracting, healthcare consulting, and Medicare Advantage experience
• 2+ years of clinic or hospital experience and/or managed care experience
• 1+ years of experience with Hospital or provider office EMR
• 1+ years of coding performed at a health care facility
• Territory management experience
• Experience in Risk Adjustment, HEDIS/Stars, and gap closure initiatives
• Experience in management position in physician practice
• Project management experience
• Knowledge of billing/claims submission and other related actions
• Advanced proficiency in MS Office (Excel (Pivot tables, excel functions)
• Proven nursing background i.e. LPN, RN, BSN
• Proven effective ability to communicate with multiple stakeholders at various levels and the ability to collaborate with cross functional teams
• Demonstrated ability to take responsibility and is internally driven to accomplish goals and recognize what needs to be done to achieve goals
• Demonstrated ability to turn situations around and go above and beyond to meet the needs of the customer

*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.
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.