Impress employers and recruiters.
Choose from hundreds of resume examples.

Target Resume Now

About the Role

Optum Insight is dedicated to improving health data flow and creating a more connected system by removing friction and driving alignment between care providers, payers, and consumers. We leverage industry expertise and innovative technology to help organizations reduce costs while enhancing risk management, quality, and revenue growth. Join us to make a difference in people's lives through Caring, Connecting, and Growing together.

Responsibilities

Manage provider groups in a defined market with fewer than 250 members.
Locate medical screening results and documentation to ensure closure of gaps in care or suspect medical conditions, under supervision.
Perform activities such as data collection, data entry, quality monitoring, HQPAF submission, and chart collection.
Partner with leadership and practice staff to develop strategies supporting the practice and members.
Utilize data analysis to identify providers who would benefit from coding, documentation, and quality training.
Establish positive, long-term relationships with physicians, medical groups, IPAs, and hospitals.
Provide actionable solutions to improve documentation and coding accuracy.
Anticipate customer needs and proactively develop solutions.
Optimize customer satisfaction, impact gap closure, and improve productivity.
Manage time effectively to meet productivity goals.
Apply problem-solving, critical thinking, and professional judgment to resolve issues.
Adhere to corporate requirements, industry regulations, and HIPAA.
Function independently to educate physicians on OPTUM tools and programs for Medicare & Medicaid Advantage Members.
Educate providers on Medicare quality programs and CMS-HCC Risk Adjustment methodology.
Support providers in aligning documentation with ICD-10, CPT II coding guidelines, and national standards.
Travel within the assigned territory up to 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 data manipulation, document creation, and presentation skills.
Demonstrated ability to communicate, engage, and develop relationships across diverse audiences and collaborating teams.
Must be able to/willing to travel approximately 75% of the time in the assigned territory (Bronx NY Regional Area).
Reside within the Bronx NY Regional Area to perform daily travel requirements.
Access to reliable personal transportation for daily travel.
Valid Driver’s License and current auto insurance.
Must adhere to UnitedHealth Group’s Telecommuter Policy if working remotely.

Skills

Medical terminology
Clinical issues knowledge
EMR systems
ICD-10
HEDIS
Stars programs
MS Office (Excel, Word, PowerPoint)
Data manipulation
Document creation
Presentation delivery
Communication
Engagement
Relationship development
Problem-solving
Critical thinking
Provider network management
Physician contracting
Healthcare consulting
Medicare Advantage sales
Pharmaceutical sales
Territory management
Certified Professional Coder (CPC/CPC-A) or equivalent certification
CRC certification
Nursing background (LPN, RN, NP)
Managed care experience
Physician office experience
Clinic experience
Hospital experience
Risk Adjustment
Gap closure initiatives
Advanced MS Excel (pivot tables, advanced functions)
Billing software knowledge
Claims submission software knowledge
Coding software knowledge
Project management

Location

Bronx, NY

Work Type

Remote
Hybrid
Onsite

Experience Level

Associate
2+ years
1+ years
Advanced

Education Level

Certified Professional Coder (CPC/CPC-A) or equivalent certification
CRC certification
Nursing background (LPN, RN, NP)

Salary/Compensations

$60,200 - $107,400

Benefits

Comprehensive benefits package
Incentive and recognition programs
Equity stock purchase
401k contribution

About the Company

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.
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.

Equal Opportunity

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.