Practice Performance Manager - Medicare Consultant , Nebraska

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The Practice Performance Manager - Consultant is responsible for program implementation and provider performance management which is tracked by designated provider metrics, inclusive minimally of 4 STAR gap closure and coding accuracy demonstrating full assessment and suspect closure.
The individual in this role is expected to work 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 needed results.
This individual will review charts (paper and electronic - EMR), identify gaps in care and open suspect opportunities, and educate providers and offices to ensure they are coding to the highest specificity for both risk adjustment and quality reporting.
Work is primarily performed at physician practices on a daily basis.

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

Primary Responsibilities:

• Functioning independently, travel across assigned territory to meet with providers to discuss UHC and Optum tools and UHC incentive programs for both risk adjustment and quality reporting, focused on improving the quality of care for Medicare Advantage Members
• Establish positive, long-term, consultative relationships with physicians, medical groups, IPAs and ACOs
• Develop comprehensive, provider-specific plans to increase their HEDIS performance, facilitate risk adjustment suspect closure and improve their outcomes
• Access PCOR to identify risk adjustment opportunities and utilize other available reporting sources including but not limited to (InSite, Spotlight, Doc360, Provider Scorecard, CPT II Report) to analyze data and prioritize gap and suspect closure, identify trends and drive educational opportunities
• Conduct chart review quarterly and provide timely feedback to provider to improve reporting on a go forward basis.
  
• Conduct additional chart reviews such as a quarterly post-visit ACV review and various focused progress notes reviews with provider feedback to improve documentation and coding resulting in improved gap and suspect closure.
  
• Coordinates and provides ongoing strategic recommendations, training and coaching to provider groups on program implementation and barrier resolution.
  
• Training will include Stars measures (HEDIS/CAHPS/HOS/medication adherence), coding for quality care (CPT II) and exclusions (ICD-10-CM), risk adjustment coding practices (ICD-10-CM), and Optum program administration including use of plan tools, reports and systems
• Lead regular Stars and risk adjustment specific JOC meetings with provider groups to drive continual process improvement and achieve goals
• Provide reporting to health plan leadership on progress of overall performance, MAPCPi, MCAIP, gap closure, and use of virtual administrative resources
• Facilitate/lead monthly or quarterly meetings, as required by plan leader, including report and material preparation
• Collaborates and communicates with the member's health care and service with our interdisciplinary delivery team to coordinate the care needs for the member
• Partner with providers to engage in UnitedHealthcare member programs such as HouseCalls, clinic days, Navigate4Me
• Willing to travel up to 75-80% for business meetings (including client/health plan partners and provider meetings) and 20-25% remote work

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:

• 5+ years of healthcare industry experience
• 2+ years of Medicare Advantage including Stars and Risk Adjustment
• 1+ years of provider facing experience
• Currently be a Certified Risk Adjustment Coder (CRC via AAPC) or either:
  Certified Professional Coder (CPC via AAPC) or Certified Coding Specialist - Physician-based (CCS-P via AHIMA)
  • with the requirement to obtain both certifications within first year in position (CRC or CPC) within 1 year of hire, if not currently possessing both
• Intermediate level experience Microsoft Office experience including Excel with exceptional analytical and data representation expertise and PowerPoint
• Willing to travel up to 75-80% for business meetings (including client/health plan partners and provider meetings) and 20-25% remote work
• Reside in the state of Nebraska

Preferred Qualifications:

• Registered Nurse
• Experience working for a health plan and/or within a provider office
• Experience with network and provider relations/contracting
• Experience retrieving data from EMRs (electronic medical records)
• Experience in management or coding position in a provider primary care practice
• Knowledge base of clinical standards of care, preventive health, and Stars measures
• Knowledge of billing or claims submission and other related actions

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

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.
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