Associate Healthcare Advocate - Field Position

About the Role

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. The Associate Healthcare Advocate is responsible for a range of provider relations services within Optum, working as an extension of the local Provider Performance Team by aligning to geographical regions, medical centers, and/or physician practices that manage a high volume of membership.

Under the supervision of a Director, Manager, and/or Mentor, you will be responsible for successful program implementation, compliance with network requirements, network assessment and selection, and program/product implementation. If you are located in Bronx, NY, you will have the flexibility to work remotely.

Responsibilities

• Manage provider groups in a defined market, limited to groups with specific needs.
• Locate medical screening results/documentation to ensure the closure of gaps in care/suspect medical conditions (will not conduct any evaluation or interpretation of clinical data; supervised by licensed and/or certified staff).
• Activities may include data collection, data entry, quality monitoring, HQPAF submission, and chart collection activities.
• Partner with your leadership team, practice administrative or clinical staff to determine best strategies to support the practice and members.
• 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.
• Provide measurable, actionable solutions to improve documentation and coding accuracy.
• Anticipate customer needs and proactively develop solutions to meet them.
• Optimize customer satisfaction, positively impact the closing of gaps in care, and maintain productivity.
• Manage time effectively to ensure productivity goals are met.
• Problem-solve, use best professional judgment, and apply critical thinking techniques to resolve issues.
• Adhere to corporate requirements related to industry regulations/responsibilities.
• Maintain confidentiality and adhere to HIPAA requirements.
• Function independently, meeting with physicians to discuss Optum tools and programs focused on improving the quality of care for Medicare & Medicaid Advantage Members.
• Educate providers on Medicare quality programs and CMS-HCC Risk Adjustment methodology, emphasizing accurate chart documentation for proper reimbursement.
• Support providers in ensuring documentation aligns with ICD-10 and CPT II coding guidelines and national standards.
• Travel within assigned territory (day trips) 75% of the time.
• Perform other duties as assigned.

Requirements

• 2+ years of healthcare experience with demonstrated knowledge of medical terminology and clinical issues.
• 1+ years of experience with EMR systems.
• Demonstrated knowledge of ICD-10, HEDIS, and Stars programs.
• Demonstrated experience using MS Office (Excel, Word, PowerPoint) with ability to manipulate data, create documents, and deliver presentations.
• Demonstrated ability to communicate, engage, and develop relationships across diverse audiences and collaborating teams (e.g., providers and internal stakeholders).
• Must be able/willing to travel approximately 75% of the time in the assigned territory (Bronx, NY Regional Area) as business needs dictate.
• Reside within the Bronx, NY Regional Area to perform daily travel requirements.
• Access to reliable personal transportation to perform daily travel requirements.
• Valid Driver’s License and current auto insurance.

Preferred Qualifications

• Certified Professional Coder (CPC/CPC-A) or equivalent certification.
• CRC certification.
• Nursing background (LPN, RN, NP).
• 2+ years of managed care experience.
• Experience in a physician office, clinic, hospital, or similar medical setting.
• Experience in Risk Adjustment, HEDIS/Stars, and gap closure initiatives.
• Advanced proficiency in MS Excel (pivot tables, advanced functions).
• Demonstrated 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

The salary for this role will range from $60,200 - $107,400 annually based on full-time employment.

Benefits

• Comprehensive benefits package.
• Incentive and recognition programs.
• Equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements).