Risk Adjustment Consultant - Dallas

Overview

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.

If you are located in Dallas and surrounding areas, you will have the flexibility to work remotely as you take on some tough challenges.

• 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

• 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

• 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

All employees working remotely will be required to adhere to United Health 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…