Risk Adjustment Consultant - Field-based - Houston, TX

UnitedHealth Group•Houston, TX

6d•Onsite

About The Position

Optum Insight is 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, and ultimately consumers. Our deep expertise in the industry and innovative technology empower us to help organizations reduce costs while improving risk management, quality and revenue growth. Ready to help us deliver results that improve lives? Join us to start Caring. Connecting. Growing together. The Healthcare Advocate serves as a strategic partner to physicians, medical groups, IPAs, and hospitals, supporting 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. This role focuses 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. This is a field-based position based in Houston, TX.

Requirements

2+ years of healthcare experience with solid knowledge of medical terminology and clinical issues
2+ years of experience in Risk Adjustment, HEDIS/Stars, and gap closure initiatives
1+ years of experience with EMR systems
Experience in a physician office, clinic, hospital, or similar medical setting
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
Proven self-driven, goal-oriented, and able to work independently while prioritizing tasks and meeting deadlines
Proven ability and willingness to travel up to 80%25 within Houston and surrounding area; reliable personal transportation
Live in Houston, TX or surrounding area

Nice To Haves

Certified Professional Coder (CPC/CPC-A) or equivalent certification
CRC certification
2+ years of clinic/hospital or managed care experience
2+ years coding experience
Project management experience
Experience in provider network management, physician contracting, healthcare consulting, Medicare Advantage sales, or pharmaceutical sales
Territory management experience
Knowledge of billing, claims submission, and coding software
Nursing background (LPN, RN, NP)
Advanced proficiency in MS Excel (pivot tables, advanced functions)

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
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