Remote Risk Adjustment Coder Jobs in Newark, NJ (NOW HIRING)

OptumInsightis 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, andultimately consumers. Our deepexpertisein the industry and innovative technology empower us to help organizations reduce costs while improving risk management,qualityand revenue growth. Ready to help us deliver results that improve lives?Join us to startCaring. Connecting. Growing together.  

The Associate Healthcare Advocate is responsible for a range of provider relations services within Optum.   The Associate Healthcare Advocate will work as an extension of the local Provider Performance Team by aligning to geographical regions, medical centers and/or physician practices that manage a high volume of membership. The Associate Healthcare Advocate under the supervision of a Director/ Manager and or Mentor is responsible for the successful program implementation, compliance with network requirements, network assessment and selection, and program/product implementation.

If you are located in Bronx, NY, you will have the flexibility to work remotely* as you take on some tough challenges.

Primary Responsibilities:  

• Manage provider groups in a defined market, limited to groups with < 250 members
• Locate medical screening results/documentation to ensure the closure of gaps in care/suspect medical conditions. Will not conduct any evaluation or interpretation of Clinical data and will be supervised by licensed and/or certified staff
• Activities may include data collection, data entry, quality monitoring, HQPAF submission and chart collection activities
• Partner with your leadership team, the practice administrative or clinical staff to determine best strategies to support the practice and our members
• 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
• Provide measurable, actionable solutions to improve documentation and coding accuracy. 
• Anticipate customer needs and proactively develop solutions to meet them 
• Optimize customer satisfaction, positively impact the closing of gaps in care and productivity
• Manage time effectively to ensure productivity goals are met 
• Ability to problem solve, use best professional judgment and apply critical thinking techniques to resolve issues as they arise Adhere to corporate requirements related to industry regulations/responsibilities
• Maintain confidentiality and adhere to HIPAA requirements
• Function independently, meeting with physicians to discuss OPTUM tools and programs focused on improving the quality of care for Medicare & Medicaid Advantage Members
• 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
• Ability to travel within assigned territory (day trips) 75% of the time
• Other duties, as assigned

You'llbe 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 asprovidedevelopment for other roles you may be interested in.

Required Qualifications: 

• 2 years of healthcare experience with demonstrated knowledge of medical terminology and clinical issues
• 1 years of experience with EMR systems
• Demonstrated knowledge of ICD-10, HEDIS, and Stars programs
• Demonstrated experience using MS Office (Excel, Word, PowerPoint) with ability to manipulate data, create documents, and deliver presentations
• Demonstrated ability to communicate, engage, and develop relationships across diverse audiences and collaborating teams (i.e., providers and internal stakeholders)
• Must be able/willing to travel approximately 75% of the time in the assigned territory (Bronx NY Regional Area) as business needs dictate
• Reside within the Bronx NY Regional Area to perform daily travel requirements
• Access to reliable personal transportation to perform daily travel requirements
• Valid Driver's License and current auto insurance

Preferred Qualifications: 

• Certified Professional Coder (CPC/CPC-A) or equivalent certification.
• CRC certification
• Nursing background (LPN, RN, NP)
• 2 years of managed care experience
• Experience in a physician office, clinic, hospital, or similar medical setting
• Experience in Risk Adjustment, HEDIS/Stars, and gap closure initiatives
• Advanced proficiency in MS Excel (pivot tables, advanced functions)
• Demonstrated knowledge of billing, claims submission, and coding software
• Project management experience
• Experience in provider network management, physician contracting, healthcare consulting, Medicare Advantage sales, or pharmaceutical sales
• Territory management experience

*All employees working remotely will berequiredto 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 $60,200 - $107,400 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,locationand 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 marginalizedgroupsand those with lower incomes. We are committed to mitigating our impact on the environment and enabling and deliveringequitablecare 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 adrug -free workplace. Candidatesare required topass a drug test before beginning employment.