Director of Coding Operations and Compliance - Hybrid Remote in Irvine, CA

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.(sm)

The Director of Risk Adjustment Coding Operations and Compliance is a key strategic leader responsible for driving accurate coding, documentation, and other risk adjustment activities for OptumCA’s Medicare Advantage and other lines of business. This leader will have accountability for multiple markets, including 5+ legacy Care Delivery Organizations (CDOs) to optimize coding and accuracy operations and ensure compliance.

This leader is accountable for the performance and direction through multiple layers of management and senior level professional staff. This leader must have expertise operating in a value-based care environment, expert knowledge on coding guidelines and CMS regulations and requirements as it relates to risk adjustment.

If you are located in Irvine, CA, you will have the flexibility to telecommute,* as well as work in the office as you take on some tough challenges.

Primary Responsibilities:

• Works collaboratively with Optum CA leadership, Optum national team, medical directors, and internal/external stakeholders to develop, implement, and measure effectiveness of coding quality improvement and compliance programs
• Ensures that local documentation and coding practices meet Optum enterprise practice guidelines and compliance goals
• Leads change, innovation, and continuous improvement efforts across coding accuracy programs. This includes implementation of best practices and standards
• Clearly defines, documents, monitors, and maintains coding workflows, productivity, and quality standards
• Ensures Optum CA Provider and Member Incentive programs are appropriately reviewed and approved by Optum governance team
• Oversees operations of concurrent coding as well as retrospective chart reviews
• Leads internal audit programs for provider coding accuracy improvement and ensures adequacy of internal controls and documentation
• Manages and oversees all CMS and health plans’ Risk Adjustment Data Validation (RADV) projects
• Keeps abreast with CMS rules, regulations, and rates as well as coding requirements. Serves as the coding accuracy subject matter expert for OptumCA
• Develops a strong relationship with health plan partners, vendors, and internal/external teams
• Assists with coding, documentation, and billing related questions
• Directs large team to resolve business problems that affect multiple functions or disciplines
• Leads a team of 3-5+ Senior Manager and/or Director-level reports, with their own respective teams focused on these topics
• Full accountability for a team of business analysts and certified coders, including but not limited to hiring, mentoring, professional development, annual review, compensation adjustment, corrective actions and termination Develops and communicates performance metrics and expectations
• Reports to the VP Risk Adjustment Shared Services leader for the OptumCA with significant exposure to market level and national Chief Medical Officers, Chief Operational Officers, and Chief Financial Officers
• Consistently exhibits behavior and communication skills that demonstrate Optum's commitment to superior customer service, including quality, care and concern with each and every internal and external customer
• Regular and consistent attendance
• Additional special projects as needed

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:

• Bachelor’s Degree or equivalent experience
• 5+ years of experience with Medicare managed care programs
• 5+ years of experience with risk adjustment coding and compliance operations
• 3+ years of management and leadership experience
• Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation

Preferred Qualifications:

• Coding Licensure/Certification (CCS-P, CPC, RHIA or RHIT)

Knowledge, Skills, Abilities:

• Expert knowledge of CMS regulations and requirements as it relates to risk adjustment
• Comprehensive knowledge of coding, documentation and billing in CPT, HCPCS, ICD-10
• Proficiency in Microsoft applications, including Outlook, Word, Excel and Power Point
• Excellent verbal and written communication skills
• Ability to effectively interface with teammates, clinicians, and management
• Ability to effectively facilitate meetings with a large audience (100+ clinicians)
• Demonstrated ability to document standard operating procedures
• Demonstrated auditing knowledge for coding quality and compliance
• Professional demeanor and demonstrated leadership ability
• High level of integrity and management of confidential information
• Demonstrated success working in dynamic, fast-paced environment

To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)

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

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.

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