Healthcare Advocate - Field Position

UnitedHealth Group•Fairfax, VA

8h•$72,800 - $130,000

About The Position

Optum Insight is seeking a Healthcare Advocate to provide provider relations services as an extension of the local Provider Performance Team. The role aligns with geographical regions, medical centers, and physician practices managing high membership volumes. Under the supervision of a Director, Manager, and/or Mentor, the Healthcare Advocate supports successful program implementation, compliance with network requirements, network assessment and selection, and program and product implementation. The position focuses on building consultative relationships with providers and helping them improve documentation, coding accuracy, risk adjustment performance, quality outcomes, and gap closure for Medicare Advantage members. The role involves independent travel throughout an assigned territory, approximately 75% of the time as specified in the travel requirement, with occasional overnight travel. The position is based in the Fairfax, Virginia regional area, and the employee must live there and have reliable personal transportation, a valid driver's license, and current auto insurance. The salary range is $72,800–$130,000 annually based on full-time employment. Benefits include a comprehensive benefits package, incentive and recognition programs, an equity stock purchase plan, and a 401(k) contribution, subject to eligibility requirements. UnitedHealth Group describes its workplace as inclusive and equal-opportunity, and requires candidates to pass a drug test before beginning employment.

Requirements

At least 3 years of healthcare experience, with strong knowledge of medical terminology and clinical issues.
At least 1 year of experience with EMR systems.
Demonstrated knowledge of ICD-10, HEDIS, and Stars programs.
Ability to identify automation opportunities and leverage AI to improve productivity and quality.
Experience using MS Office, including Excel, Word, and PowerPoint, with the ability to manipulate data, create documents, and deliver presentations.
Ability to communicate, engage, and develop relationships across diverse audiences and collaborating teams, including providers and internal stakeholders.
Ability and willingness to travel approximately 75% of the time in the assigned territory as business needs dictate.
Must live within the Fairfax, Virginia regional area to meet daily travel requirements.
Must have reliable personal transportation for daily travel requirements.
Must provide proof of a valid driver's license and current auto insurance.

Nice To Haves

Certified Professional Coder (CPC/CPC-A) or equivalent certification.
CRC certification.
Nursing background (LPN, RN, or NP).
At least 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, including pivot tables and advanced functions.
Knowledge of billing, claims submission, and coding software.
Project management experience.
Previous experience in provider network management, physician contracting, healthcare consulting, Medicare Advantage sales, or pharmaceutical sales.
Territory management experience.

Responsibilities

Act as a trusted advisor and strategic partner to providers and medical groups, assisting with accurate documentation and coding that reflect members’ health status.
Travel independently across the assigned territory to engage providers in Optum tools and programs supporting quality of care for Medicare Advantage members.
Gain provider participation in and deployment of Prospective Programs, achieving business goals and metrics.
Use data analysis to identify and target providers who would benefit from coding, documentation, and quality training resources.
Establish positive, long-term consultative relationships with physicians, medical groups, IPAs, and hospitals.
Develop and implement provider-specific plans to improve RAF performance, coding specificity, and gap closure.
Manage Risk Adjustment and Quality programs end to end, including In-Office Assessment initiatives.
Consult with provider groups about documentation and coding gaps and provide actionable feedback to improve compliance with CMS standards.
Guide providers on EMR/EHR issues that affect documentation and coding accuracy.
Collaborate with multidisciplinary teams to implement prospective programs as directed by leadership.
Educate providers on Medicare quality programs and CMS-HCC Risk Adjustment methodology, emphasizing accurate chart documentation.
Support provider documentation in alignment with ICD-10 and CPT II coding guidelines and national standards.
Deliver ICD-10 HCC coding training and develop tools for providers and office staff.
Provide measurable, actionable solutions to improve documentation and coding accuracy.
Partner with physicians, coders, and facility staff on Risk Adjustment and Quality education efforts.
Assist with chart collection and analysis as needed.