Experienced Telecommute Healthcare Advocate and Medicare Advantage Specialist - Remote Opportunity for Passionate Healthcare Professionals
Introduction to Our Company and Industry
As a leader in the healthcare industry, our company is dedicated to improving the quality of care for Medicare Advantage members. We are seeking a highly skilled and passionate Telecommute Healthcare Advocate to join our team. This is a unique opportunity to make a difference in the lives of patients and healthcare providers while working in a modern, remote environment. Our company values innovation, collaboration, and excellence, and we are committed to providing our employees with a supportive and dynamic work environment.
Job Overview
In this role, you will have the flexibility to telecommute from Western, KY, and will be responsible for traveling across your assigned territory to meet with healthcare providers and discuss Optum tools and programs focused on improving the quality of care for Medicare Advantage members. You will utilize data analysis to identify and target providers who would benefit from our coding, documentation, and quality training and resources. Your goal will be to establish positive, long-term, consultative relationships with physicians, medical groups, IPAs, and hospitals, and to develop comprehensive, provider-specific plans to increase their RAF performance and improve their coding specificity.
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 (approximately 80% of time)
• Utilize data analysis to 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, including the Healthcare Patient Assessment Form, to ensure 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 the Medicare quality program and CMS-HCC Risk Adjustment program as it relates to payment methodology and the importance of proper chart documentation of procedures and diagnosis coding
• Support providers in ensuring documentation supports the submission of relevant ICD-10 codes and CPT2 procedural information in accordance with national coding guidelines and appropriate reimbursement requirements
• Provide ICD10-HCC coding training to providers and appropriate office staff as needed
• Develop and present coding presentations and training to large and small groups of clinicians, practice managers, and certified coders
• Develop and deliver diagnosis coding tools to providers
• Train physicians and other staff regarding documentation, billing, and coding, and provide feedback to physicians regarding documentation practices
• Provide measurable, actionable solutions to providers that will result in improved accuracy for documentation and coding practices
• Collaborate 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
Requirements and Qualifications
To be successful in this role, you will need to have a strong foundation in healthcare and a diverse skillset. The following qualifications are required:
• Bachelor's degree (preferably in Healthcare or a related field) or equivalent work experience
• Proficiency in MS Office (Excel, PowerPoint, and Word), including experience with pivot tables and Excel functions
• Ability to work effectively with common office software, coding software, EMR, and abstracting systems
• Excellent verbal and written communication skills, with the ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand
• Proven ability to effectively engage, manage, and maintain relationships with physicians, hospitals, health systems, clinical, and non-clinical personnel
• Ability to travel within the state up to 75% of the time to client locations
• Full COVID-19 vaccination is an essential job function of this role, and candidates must comply with all federal, state, and local regulations, as well as client requirements
Preferred Quali
As a leader in the healthcare industry, our company is dedicated to improving the quality of care for Medicare Advantage members. We are seeking a highly skilled and passionate Telecommute Healthcare Advocate to join our team. This is a unique opportunity to make a difference in the lives of patients and healthcare providers while working in a modern, remote environment. Our company values innovation, collaboration, and excellence, and we are committed to providing our employees with a supportive and dynamic work environment.
Job Overview
In this role, you will have the flexibility to telecommute from Western, KY, and will be responsible for traveling across your assigned territory to meet with healthcare providers and discuss Optum tools and programs focused on improving the quality of care for Medicare Advantage members. You will utilize data analysis to identify and target providers who would benefit from our coding, documentation, and quality training and resources. Your goal will be to establish positive, long-term, consultative relationships with physicians, medical groups, IPAs, and hospitals, and to develop comprehensive, provider-specific plans to increase their RAF performance and improve their coding specificity.
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 (approximately 80% of time)
• Utilize data analysis to 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, including the Healthcare Patient Assessment Form, to ensure 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 the Medicare quality program and CMS-HCC Risk Adjustment program as it relates to payment methodology and the importance of proper chart documentation of procedures and diagnosis coding
• Support providers in ensuring documentation supports the submission of relevant ICD-10 codes and CPT2 procedural information in accordance with national coding guidelines and appropriate reimbursement requirements
• Provide ICD10-HCC coding training to providers and appropriate office staff as needed
• Develop and present coding presentations and training to large and small groups of clinicians, practice managers, and certified coders
• Develop and deliver diagnosis coding tools to providers
• Train physicians and other staff regarding documentation, billing, and coding, and provide feedback to physicians regarding documentation practices
• Provide measurable, actionable solutions to providers that will result in improved accuracy for documentation and coding practices
• Collaborate 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
Requirements and Qualifications
To be successful in this role, you will need to have a strong foundation in healthcare and a diverse skillset. The following qualifications are required:
• Bachelor's degree (preferably in Healthcare or a related field) or equivalent work experience
• Proficiency in MS Office (Excel, PowerPoint, and Word), including experience with pivot tables and Excel functions
• Ability to work effectively with common office software, coding software, EMR, and abstracting systems
• Excellent verbal and written communication skills, with the ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand
• Proven ability to effectively engage, manage, and maintain relationships with physicians, hospitals, health systems, clinical, and non-clinical personnel
• Ability to travel within the state up to 75% of the time to client locations
• Full COVID-19 vaccination is an essential job function of this role, and candidates must comply with all federal, state, and local regulations, as well as client requirements
Preferred Quali