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 diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

Responsible for regulatory compliance audits, including but not limited to regulatory agencies, Quality metrics, and coding compliance. The Auditor will monitor changes to laws and regulations to ensure compliance with State and Federal laws, regulations and mandates. Establish and implement standard policies, procedures, and best practice across Optum Middle Revenue Cycle. This role is responsible for client facing meetings with the Quality Teams, CDI, and others directly related to accounts associated with prebill reviews, such as, HAC/PSIs. This position must maintain strong client relationships and represent Optum360 in all aspects of its values.

If you call yourself a data guru, then you'll be perfect for this role. As you respond to inquiries, requests and actions, you'll need to be able to communicate research and data findings in a meaningful way. You will also be responsible for monitoring internal and external regulatory audits.

You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Maintain and demonstrate expert knowledge of coding, coding operations, coding review of all coding staff (domestic and global) and best demonstrated coding practices; drives the integration of Optum360 Coding related business objectives within the client environment

• Serve as the expert of applicable Federal, State, and local laws and regulations, Optum360’s organizational integrity program, standards of conduct, as well as other policies and procedures to ensure adherence in a manner that reflects honest, ethical, and professional behavior. Promotes a service-oriented culture within the organization and assures satisfaction with the quality and amount of support provided for departmental functions, initiatives, and projects

• Communicate the potential impact of compliance issues and risks on our business, operations, and consumers to applicable stakeholders, including both segment-specific and enterprise-wide implications

• Collaborate with applicable regulators (e.g., CMS) to prevent or address potential compliance issues within our organization

• Conduct internal monitoring/auditing to identify process gaps and help the business address organizational risks

• Collaborate with internal stakeholders across organization lines to help identify root causes of compliance issues, and support appropriate action to mitigate risk, as needed

• Analyze results of audits and monitoring processes to identify potential risks (e.g., risk assessments), and communicate as needed

• Identify and analyze applicable patterns/trends (e.g., using data analysis, news reports, reported concerns) to identify potential compliance issues, and communicate as needed (e.g., fraud, waste and abuse)

• Develop and/or deliver training on compliance issues and risks to applicable audiences

• Consult with internal and external stakeholders to advocate and drive effectiveness of our compliance programs (e.g., government regulators, legal staff, vendors)

• Partner with applicable learning organizations as needed to develop/implement compliance training offerings (e.g., Learning & Development)

• Consult with applicable business partners to identify effective approaches to support/enforce compliance within their business

• Provide input on business training programs as needed to promote inclusion of appropriate compliance content (e.g., specialized compliance training)

• Assess and respond to the need for required compliance training among external stakeholders, as appropriate (e.g., vendors, delegated entities)

• Provide quality performance feedback by completing internal coding quality audits to the coding specialist staff, coding team leadership, and coding educators

• Act as liaison for all external quality stakeholders which include but not limited to compliance, core measures, patient safety, and premier data integrity

• Support coding team leadership with quality data reporting and work with coding educators on opportunities for educational topics for coders

• Other duties as needed and assigned by Optum360 leadership

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:

• High School Diploma/GED (or higher)

• AAPC or AHIMA (CCS, CPC, RHIT or RHIA) certification

• 5+ years of experience with IP and/or OP coding and/or in a coding reviewer role, prefer recent experience

• 1+ years of experience working collaboratively with CDI and quality leadership in partnership to improve reimbursement and coding accuracy

• 1+ years of experience with computer assisted coding technologies and EMR (Electronic Medical Record) coding workflow

• Intermediate level of proficiency with Microsoft Excel, Word, PowerPoint, and SharePoint

Preferred Qualifications:

• Excellent organizational skills required (ability to multi-task, produce rapid turnaround, and effectively manage multiple projects)

• Ability to work with a variety of individuals in executive, managerial and staff level positions. The incumbent frequently interacts with staff at the Corporate/National, Regional and Local organizations. May also interact with external parties, such as financial auditors, third party payer auditors, consultants, and various hospital associations

• Must possess a personal presence that is characterized by a sense of honesty, integrity, and caring with the ability to inspire and motivate others to promote the philosophy, mission, vision, goals, and values of Optum360 and our client organization(s)

• Operational knowledge of health care related Federal and State regulations, as well as standards from regulatory agencies and accrediting organizations (e.g., CMS, TJC)

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

The salary range for this role is $59,500 to $116,600 annually based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

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.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity / Affirmative Action employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

#RPO #GREEN