Risk Adjustment Advocate - Minneapolis and surrounding areas - Field Based

UnitedHealth Group•Minneapolis, MN

8d•Hybrid

About The Position

Optum Insight is dedicated to improving health data flow for a more connected system, reducing friction between care providers and payers, and enhancing risk management, quality, and revenue growth. The Healthcare Advocate acts as a strategic partner to physicians, medical groups, IPAs, and hospitals. This role supports accurate documentation and coding practices to ensure a complete and accurate health picture of members across government and regulated lines of business, including Medicare Advantage, Medicaid, and ACA. The primary focus is on improving quality of care, closing gaps in care, and driving performance in Risk Adjustment and Quality programs through education, collaboration, and data-driven strategies. The position offers flexibility to work remotely for those located in Minneapolis, MN and surrounding areas, while taking on challenging tasks.

Requirements

2+ years of experience in a physician office, clinic, hospital, or similar medical setting
2+ years of experience with ICD-10, HEDIS, and Stars programs
1+ years of experience with EMR systems
Proficiency in MS Office (Excel, Word, PowerPoint) with ability to manipulate data, create documents, and deliver presentations
Proven solid communication skills with ability to engage multiple stakeholders and collaborate across teams
Ability to be self-driven, goal-oriented, and able to work independently while prioritizing tasks and meeting deadlines
Ability to travel up to 75%25 within designated market
Current driver’s license and access to reliable personal transportation

Nice To Haves

Certified Professional Coder (CPC/CPC-A) or equivalent certification
CRC certification
2+ years of clinic/hospital or managed care experience
Nursing experience (LPN, RN, NP)
Advanced proficiency in MS Excel (pivot tables, advanced functions)
Experience in Risk Adjustment, HEDIS/Stars, and gap closure initiatives
Proven 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

Responsibilities

Act as a trusted advisor and strategic partner to providers and medical groups, assisting in accurate documentation and coding to reflect members’ true health status
Travel independently across the assigned territory (approximately 80%25 field-based, with occasional overnight travel) to engage providers in Optum tools and programs that enhance quality of care for Medicare Advantage members
Responsible for gaining participation and deployment of Prospective Programs achieving business goals and metrics
Utilize 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 comprehensive, provider-specific plans to improve RAF performance, coding specificity, and gap closure
Manage end-to-end Risk Adjustment and Quality programs, including In-Office Assessment initiatives
Consult with provider groups on documentation and coding gaps; provide actionable feedback to improve compliance with CMS standards
Offer guidance on EMR/EHR system issues impacting 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 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
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 in chart collection and analysis as needed