Field-Based Risk Adjustment & Coding Advocate

Optum; Honolulu (HI); On-site; USD 73,000 - 130,000; Full time

Job summary

OptumInsight is improving the flow of health data and information to create a more connected system. This role focuses on accurate documentation and coding to reflect members' true health status, driving RAF performance and quality programs in Medicare Advantage and other lines.

The Healthcare Advocate serves as a strategic partner to physicians, medical groups, IPAs, and hospitals, with extensive field travel from Honolulu, HI.

Qualifications

• 3+ years of healthcare experience with solid knowledge of medical terminology and clinical issues.
• 2+ years of experience with EMR systems.
• Experience in a physician office, clinic, hospital, or similar medical setting.
• Demonstrated knowledge of ICD-10, HEDIS, and Stars programs.
• Demonstrated proficiency in MS Office (Excel, Word, PowerPoint) with ability to manipulate data, create documents, and deliver presentations.
• Demonstrated ability to identify automation opportunities and leverage AI to improve productivity and quality.
• Reside in the Honalulu, HI area to perform daily field travel requirements.
• Able/willing to travel approximately 80% of the time, this is a field-based position that required daily local state travel.
• Proof of a valid Driver's License, reliable transportation, and current auto insurance to perform daily local state travel.

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% 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
• Demonstrated communication skills with ability to engage multiple stakeholders and collaborate across teams
• Self-driven, goal-oriented, and able to work independently while prioritizing tasks and meeting deadlines

Skills

Healthcare experience

EMR systems

Communication skills

Travel willingness

Data analysis

AI productivity

Tools

MS Office

MS Excel

Job description

OptumInsight is improving the flow of health data and information to create a more connected system. This role focuses on accurate documentation and coding to reflect members' true health status, driving RAF performance and quality programs in Medicare Advantage and other lines.

The Healthcare Advocate serves as a strategic partner to physicians, medical groups, IPAs, and hospitals, with extensive field travel from Honolulu, HI.