Practice Manager - Medicare Consultant - Field KY

Overview

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 diversity and inclusion, talented peers, comprehensive benefits and career development opportunities.

Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

• 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, Doc
  360, 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 United Healthcare member programs such as House Calls, clinic days, Navigate4
  
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• Weekly commitment of 75% travel for business meetings (including client/health plan partners and provider meetings) and 40% remote work

This is a field based position in KY with the ability to cover Morehead, Ashland, and Pikeville regions.

• Certified Risk Adjustment Coder (CRC via AAPC) or Certified Professional Coder (CPC via AAPC). If you do not have both the CRC AND CPC, it will be required to obtain both AAPC certifications within first year in position (CRC within 6 months of hire and CPC within 1 year of hire, if not currently CPC or CCS-P)
• 5+ years of healthcare industry experience
• 1+ years of provider facing experience
• 1+ years of Account Management or Sales Account experience
• Microsoft Office experience including Excel with exceptional analytical and data representation expertise
• Proven solid knowledge of Medicare Advantage including Stars and Risk Adjustment
• Proven knowledge of ICD-10-CM and CPT II coding
• Proven solid relationship building skills with clinical and non-clinical personnel
• Proven excellent oral & written communication skills
• Reside within KY
• Willing and ability to travel up to 75% within KY

• 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
• Demonstrated knowledge base of clinical standards of care, preventive health, and Stars measures
• Demonstrated level of knowledge, skill and understanding of ICD-10-CM and CPT coding principles consistent with certification by AAPC or AHIMA
• Proven knowledge of billing or claims submission and other related actions
• Proven solid communication and presentation skills
• Proven solid problem-solving skills
• Demonstrated good work ethic, desire to succeed, self-starter
• Proven ability to deliver training materials designed to improve provider compliance
• Proven ability to use independent judgment, and to manage and impart confidential information

The salary…