Practice Consultant - Baltimore, MD

TieTalent; Baltimore (MD); Remote; USD 70,000 - 90,000; Full time

Job summary

A leading healthcare organization is seeking a Practice Consultant to enhance provider performance and manage program implementation. This role involves building relationships with care providers, conducting chart reviews, and ensuring high-quality coding for risk adjustment. Ideal candidates will have significant healthcare experience and relevant coding certifications, with opportunities for remote work based in Baltimore.

Qualifications

• 5+ years of healthcare industry experience.
• 1+ years provider-facing experience.
• Proficiency in Microsoft Office, especially Excel.

Responsibilities

• Travel across assigned territory to meet with providers.
• Conduct quarterly chart reviews and provide feedback.
• Develop provider-specific plans to enhance performance.

Skills

Analytical Skills

Relationship Building

Communication Skills

Education

Certified Risk Adjustment Coder (CRC)

Certified Professional Coder (CPC)

Certified Coding Specialist – Physician-based (CCS-P)

Tools

Microsoft Excel

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.

Role Overview

The Practice Consultant is responsible for program implementation and provider performance management, tracked by designated provider metrics, including at least 4 STAR gap closure and coding accuracy demonstrating full assessment and suspect closure. This role involves working 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 results. Responsibilities include chart reviews (paper and electronic - EMR), identifying gaps in care, opening suspect opportunities, and educating providers to ensure high specificity in coding for risk adjustment and quality reporting. Work is primarily performed at physician practices daily.

Location

If you are located in Baltimore, MD, you will have the flexibility to work remotely* as you take on some tough challenges.

Primary Responsibilities

1. Travel across assigned territory to meet with providers, discuss UHC and Optum tools, and incentive programs to improve care quality for Medicare Advantage Members.
2. Establish positive, long-term relationships with physicians, medical groups, IPAs, and ACOs.
3. Develop provider-specific plans to enhance HEDIS performance, facilitate risk adjustment suspect closure, and improve outcomes.
4. Utilize PCOR and other reporting sources (InSite, Spotlight, Doc360, Provider Scorecard, CPT II Report) to analyze data, prioritize gap closure, identify trends, and drive educational opportunities.
5. Conduct quarterly chart reviews, providing timely feedback to providers.
6. Perform additional chart reviews (post-visit ACV, progress notes) with provider feedback to improve documentation and coding.
7. Coordinate and deliver ongoing training and coaching on program implementation and barrier resolution.
8. Training topics include Stars measures, coding for quality care, risk adjustment coding practices, and program administration tools.
9. Lead regular Stars and risk adjustment meetings with provider groups to drive process improvements.
10. Report on overall performance progress to health plan leadership.
11. Facilitate and lead meetings, prepare reports and materials.
12. Coordinate care with interdisciplinary teams to meet member needs.
13. Partner with providers to engage in member programs like HouseCalls, clinic days, Navigate4Me.
14. Travel up to 75% within the Baltimore, MD area.

Required Qualifications

• Certified Risk Adjustment Coder (CRC) via AAPC or Certified Professional Coder (CPC) via AAPC or Certified Coding Specialist – Physician-based (CCS-P) via AHIMA, with certification within the first year.
• 5+ years healthcare industry experience.
• 1+ years provider-facing experience.
• Proficiency in Microsoft Office, especially Excel, with strong analytical skills.
• Knowledge of Medicare Advantage, Stars, and Risk Adjustment.
• Understanding of ICD-10-CM and CPT II coding.
• Strong relationship-building skills with clinical and non-clinical personnel.
• Excellent oral and written communication skills.
• Reside in Baltimore, MD.
• Valid driver’s license and reliable transportation.
• Ability to travel up to 75% in the Baltimore area.

Preferred Qualifications

• Registered Nurse (RN).
• Experience in health plan or provider office settings.
• Experience with network/provider relations and contracting.
• Experience retrieving data from EMRs.
• Management or coding experience in a primary care practice.
• Knowledge of clinical standards, preventive health, and Stars measures.
• Understanding of billing and claims processes.
• Proactive work ethic, self-starter attitude.
• Ability to develop training materials for provider compliance.
• Strong judgment and confidentiality management.
• Effective communication and presentation skills.
• Problem-solving skills.

*All remote employees must adhere to UnitedHealth Group’s Telecommuter Policy.