Risk Adjustment Advocate - St Louis MO and surrounding areas - Field Based

RXinsider LTD.; Northern (KY); Hybrid; USD 73,000 - 130,000; Full time

Job summary

UnitedHealth Group is seeking a Healthcare Advocate to serve as a strategic partner to physicians, medical groups, IPAs and hospitals. The role focuses on accurate documentation and coding, improving RAF performance and closing care gaps across government and regulated lines of business.

The position is field-based in the designated territory with substantial travel (about 75%), delivering data-driven strategies, training, and tools to providers for better quality of care and compliant coding

Qualifications

• 2+ years in a physician office, clinic, hospital, or similar medical setting
• 2+ years of ICD-10, HEDIS, and Stars familiarity
• 1+ years of EMR systems experience
• Proficiency in MS Office (Excel, Word, PowerPoint) with data manipulation
• Willingness to travel up to 75% within designated market
• Current driver’s license and reliable transportation

Responsibilities

• Act as a trusted advisor to providers and medical groups for accurate documentation and coding
• Travel across the territory to engage providers in Optum tools and programs
• Develop provider-specific plans to improve RAF performance, coding, and gap closure
• Manage end-to-end Risk Adjustment and Quality programs
• Educate providers on Medicare quality programs and CMS-HCC methodology
• Provide actionable feedback to improve CMS standards compliance

Skills

Strong communication

MS Office proficiency

Data analysis

Travel readiness

Education

CPC/CPC-A certification

CRC certification

Tools

EMR systems

MS Excel (advanced)

Coding software

Job description

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 in Saint Lous, MO.

Primary 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

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

• 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% within designated market
• Current driver's license and access to reliable personal transportation

Preferred Qualifications

• 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

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you’ll find a far-reaching choice of benefits and incentives. The salary for this role will range from $72,800 to $130,000 annually based on full-time employment. We comply with all minimum wage laws as applicable.

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.