Practice Performance Manager - Medicare Consultant

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.

The Practice Performance Manager - Consultant is responsible for program implementation and provider performance management which is tracked by designated provider metrics, inclusive minimally of 4 STAR gap closure and coding accuracy demonstrating full assessment and suspect closure. The individual in this role is expected to work directly with care providers to build relationships, ensure effective education and reporting, proactively identify performance improvement opportunities through analysis and discussion with subject matter experts; and influence provider behavior to achieve needed results. This individual will review charts (paper and electronic - EMR), identify gaps in care and open suspect opportunities, and educate providers and offices to ensure they are coding to the highest specificity for both risk adjustment and quality reporting. Work is primarily performed at physician practices on a daily basis.

If you are located in Kansas, 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 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, Doc360, 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 UnitedHealthcare member programs such as HouseCalls, clinic days, Navigate4Me

Willing to travel up to 75-80% for business meetings (including client / health plan partners and provider meetings) and 20-25% remote work

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 :

Certified Risk Adjustment Coder (CRC via AAPC) or either : Certified Professional Coder (CPC via AAPC) or Certified Coding Specialist - Physician-based (CCS-P via AHIMA) with the requirement to obtain both certifications within first year in position (CRC or CPC) within one year of hire, if not currently possessing both

5+ years of healthcare industry experience

2+ years of Medicare Advantage including Stars and Risk Adjustment

1+ years of provider facing experience

Intermediate level experience Microsoft Office experience including Excel with exceptional analytical and data representation expertise and PowerPoint

Willing to travel up to 75-80% for business meetings (including client / health plan partners and provider meetings) and 20-25% remote work

Driver’s License and access to reliable transportation

Reside in the state of Kansas

Preferred Qualifications :

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

Knowledge base of clinical standards of care, preventive health, and Stars measures

Knowledge of billing or claims submission and other related actions