SME Auditor for Surgical Acute and Profee Coding – Remote

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.

The SME/Auditor for Acute & Profee Surgical will be a Subject Matter Expert in Surgical CPT coding.  The SME will have responsibility for auditing and educating both providers and coders on surgical CPT coding for Middle Revenue Cycle Coding Services Operational Team with a focus on CPT, ICD-10-CM classification, Modifier assignment, and Official Coding Guidelines.  This role will audit both acute and professional CPT code assignments.  Auditor/Educator will provide key concepts for surgical CPT coding supporting providers and coders on current regulations, coding guidelines, and payer requirements.  

Position in this function is responsible for providing oversight to Optum360 coding services, directly overseeing facility-based and/or HIM (Health Information Management) Center operations leadership of Optum 360 Coding Departments within the assigned Region. The SME will lead key initiatives within the organization related to Quality metrics, workflow improvement, and audits, etc. to meet or exceed metrics, drive efficient coding services, and deliver performance excellence through standardization of processes and focus primarily on ensuring best practices are followed within their respective facilities. The Coding SME is a critical member of the Optum360 HIM/Coding Operations team. 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.  The Coding SME drives continuous quality improvements and tracks, monitors, and trends performance to improve business objectives and to disrupt the status quo to exceed Service Level Agreement commitments. This position must maintain strong client relationships and represent Optum360 in all aspects of its values.

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

Primary Responsibilities:

• Maintains and demonstrates 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
• Identifies & builds consensus for facilitation of system and process standardization, utilization of best practices, work integration, change management, issue resolution, metric development and measurement, and communication related to the key components of coding operations:
  • Executes the integration of the Optum360 Coding functions and processes in the facilities they serve
  • Leverages standard processes, systems, or other vehicles to reduce waste and cost at the facility while improving SLAs, KPIs (Key Performance Indicators), metrics and the overall client and/or patient experience
• Works collaboratively with HIM, CDI, and Coding Operations to monitor day to day coding operations, prebill coding reviews, and prebill quality reviews
• Assists Coding Leadership with oversight of processes and initiatives designed to continuously improve coding quality and/or efficiency
• Maintains expert knowledge of coding to ensure high level of accuracy and proficiency standards of performance are achieved to meet or exceed targets
• Effectively leads and participates in coding quality assurance/compliance activities that include action plans relevant to audit results including remediation, education, and when appropriate assisting to create and monitor corrective action plans
• Serves as the liaison between the coding operations collaboratively bring each unit together including establishing, building, and maintaining cohesive relationships with the client
• Effectively utilizes tools and data provided to capture and continually improve union, client, and employee engagement. Leads initiatives towards meeting and exceeding employee satisfaction
• Leads by example; promotes teamwork by fostering a positive, transparent, and focused working environment which achieves maximum results
• Participates actively in leadership forums at the system level and leads such forums and other informational/educational offerings for assigned HIM/Coding/CDI Managers
• Provides team leadership and promotes a successful business operation by:
  • Fosters teamwork atmosphere between business and clinical stakeholders
  • Provides staff training and mentoring
  • Provides development of employees through consistent and constructive feedback geared towards accuracy
  • Rewards and recognizes performance and provides leadership direction during the common review process
  • Seeks to innovate and foster innovative ideas toward the development of staff to ensure increased employee engagement and employee satisfaction
• Other duties as needed and assigned by Optum360 leadership, including but not limited to leading and conducting special projects. Develops project work plans, facilitates resource allocation, executes project tasks and obtains assistance from other intra and inter-departmental resources, as required
• Subject Matter 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

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 recent OP coding and/or coding reviewer role experience 
• Experience working collaboratively with CDI and Quality leadership in partnership to improve reimbursement and coding accuracy
• Experience with computer assisted coding technologies and EMR (Electronic Medical Record) coding workflow
• AAPC or AHIMA (CCS, CPC, RHIT or RHIA) coding credential
• Proficiency with: Microsoft Excel, Word, PowerPoint, and SharePoint

Preferred Qualifications:

• Operational knowledge of health care related Federal and State regulations, as well as standards from regulatory agencies and accrediting organizations (e.g., CMS, TJC)
• Proven excellent organizational skills required (ability to multi-task, produce rapid turnaround, and effectively manage multiple projects) 
• Proven 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

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy 

California, Colorado, Connecticut, Hawaii, Maryland, Nevada, New Jersey, New York, Rhode Island, Washington, Washington, D.C. Residents Only: The salary range for this role is $70,200 to $137,800 annually. 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.

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.