Risk Adjustment Consultant - Field-based - Albuquerque, NM

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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. 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 role located within and around Albuquerque, NM.

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 healthcare experience with strong 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 to be self-driven, goal-oriented, and able to work independently while prioritizing tasks and meeting deadlines
• Proven ability and willingness to travel up to 80% within Albuquerque and surrounding area; reliable personal transportation required
• Must live in Albuquerque or surrounding area
• Driver's License and access to a reliable transportation
  
  Preferred Qualifications:
• Nursing background (LPN, RN, NP)
• 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
• Territory management experience
• Experience in provider network management, physician contracting, healthcare consulting, Medicare Advantage sales, or pharmaceutical sales
• Advanced proficiency in MS Excel (pivot tables, advanced functions)
• Knowledge of billing, claims submission, and coding software
   

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
 

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.

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.

Salary : $72,800 - $130,000