Practice Consultant - Baltimore, MD
Company: Optum
Location: Baltimore
Posted on: May 20, 2025
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Job Description:
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 diversity and inclusion, talented peers,
comprehensive benefits and career development opportunities. Come
make an impact on the communities we serve as you help us advance
health equity on a global scale. Join us to start Caring.
Connecting. Growing together.
The Practice 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 person 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.
The person 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.
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If you are located in Baltimore, MD, 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
Includes up to 75% local travel
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 within 6 months of hire and CPC within 1 year
of hire, if not currently CPC or CCS-P)
5+ years of healthcare industry experience -
1+ years of provider facing experience
Microsoft Office experience including Excel with exceptional
analytical and data representation expertise
Solid knowledge of Medicare Advantage including Stars and Risk
Adjustment
Knowledge of ICD-10-CM and CPT II coding
Proven solid relationship building skills with clinical and
non-clinical personnel
Proven excellent oral & written communication skills
Reside in the Baltimore, MD area
Driver's License and access to reliable transportation
Ability to travel and be in the field up to 75% in the Baltimore,
MD area
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
Demonstrate a level of knowledge, skill and understanding of
ICD-10-CM and CPT coding principles consistent with certification
by AAPC or AHIMA
Knowledge base of clinical standards of care, preventive health,
and Stars measures
Knowledge of billing or claims submission and other related
actions
Proven good work ethic, desire to succeed, self-starter
Proven ability to deliver training materials designed to improve
provider compliance
Proven ability to use independent judgment, and to manage and
impart confidential information
Proven solid communication and presentation skills
Proven solid problem-solving skills
*All employees working remotely will be required to adhere to
UnitedHealth Group's Telecommuter Policy -
The salary range for this role is $71,600 to $140,600 annually
based on full-time employment. Pay is based on several factors
including but not limited to local labor markets, education, work
experience, certifications, etc. UnitedHealth Group complies with
all minimum wage laws as applicable. In addition to your salary,
UnitedHealth Group offers benefits such as, a comprehensive
benefits package, incentive and recognition programs, equity stock
purchase and 401k contribution (all benefits are subject to
eligibility requirements). No matter where or when you begin a
career with UnitedHealth Group, you'll find a far-reaching choice
of benefits and incentives.
Application Deadline: This will be posted for a minimum of 2
business days or until a sufficient candidate pool has been
collected. Job posting may come down early due to volume of
applicants.
At UnitedHealth Group, our mission is to help people live healthier
lives and make the health system work better for everyone. We
believe everyone-of every race, gender, sexuality, age, location
and income-deserves the opportunity to live their healthiest life.
Today, however, there are still far too many barriers to good
health which are disproportionately experienced by people of color,
historically marginalized groups and those with lower incomes. We
are committed to mitigating our impact on the environment and
enabling and delivering equitable care that addresses health
disparities and improves health outcomes - an enterprise priority
reflected in our mission.
UnitedHealth Group is an Equal Employment Opportunity employer
under applicable law and qualified applicants will receive
consideration for employment without regard to race, national
origin, religion, age, color, sex, sexual orientation, gender
identity, disability, or protected veteran status, or any other
characteristic protected by local, state, or federal laws, rules,
or regulations. -
UnitedHealth Group is a drug - free workplace. Candidates are
required to pass a drug test before beginning employment.
Keywords: Optum, Annandale , Practice Consultant - Baltimore, MD, Professions , Baltimore, Virginia
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