Senior Manager of Chart Review Operations- 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 Senior Manager of Chart Review Operations will direct the operations activities for the Chart Review team which is comprised of two teams; certified medical coders, and RNs who are also certified medical coders. The Coding Review team and Clinical Review team perform claim reviews to identify billing and coding aberrancies in post-adjudicated, pre-payment professional and facility claims. The Coding Review team is responsible for professional claim reviews, while the Clinical Review team is responsible for facility claim reviews.  The Senior Manager is responsible for setting team direction, interface with teams within and outside the division, identifying and promoting continuous improvement initiatives, resolving problems, and providing guidance to team members. This role will support Pre-Pay Insight Record Review (IRR) clients and their deliverables, client support, and creating and maintaining documentation and templates for consistent, efficient, and accurate reviews. This role will also support and guide the Chart Review QA program to ensure consistency and accuracy of our Chart Review deliverables. 

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

Primary Responsibilities:

• Manages and is accountable for professional employees and/or supervisors
• Sets team direction, resolves problems, and provides guidance to members of own teams
• Identifies, develops, and adapts departmental plans and priorities to address business and operational challenges
• Influences or provides input to forecasting and planning activities
• Provides measurement and cost savings support (development, reporting, validation, and improvement) for service management
• Serves as a resource and provides expertise and guidance to entire record review, QA, clinical and/or coding teams
• Identifies, develops, initiates, and recommends opportunities for cost savings and improving outcomes
• Researches and interprets correct coding, billing, and fraud, waste and abuse guidelines and internal business rules to respond to customer inquiries
• Will manage team’s workload, production and reporting measures to ensure deadlines are met and workload is effectively balanced
• Provides complete, accurate and timely communication and responses to internal departments (including client data support, sales, account management, project management, record review, IT), as well as external clients
• Ensures projects are completed within committed time and budget and are integrated with other business and related projects
• Ensures team has tools and resources necessary for completing work efficiently, effectively, and accurately including creating and maintaining templates and documentation for reviews
• Serves as a coding resource and provides coding expertise and guidance to entire record review, clinical and/or coding teams
• Coordinate activities with varying levels of leadership, record review team, internal and external customers and medical professionals through effective verbal and written communications 
• Monitors CMS and major payer coding and reimbursement policies  

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:

• RHIA, RHIT, CCS-P, COC or CPC Coding Credential
• 3+ years of people leadership experience to include coaching and development of staff
• 3+ years of experience in reviewing/auditing professional and/or facility medical claims for aberrancies or an equivalent combination of education and experience  
• Navigation and edit resolution experience through various Web based systems, ability to use email, Excel, Word
• Experience working with and communicating directly with clients at various levels of the organization and customers
• Experience reviewing, analyzing, and researching professional and facility medical coding issues
• Reimbursement policy and/ or claims software analyst experience  

Preferred Qualifications:

• Knowledge of healthcare payment integrity
• Knowledge of claims editing software and rules development

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

California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Rhode Island, Washington or Washington, D.C. Residents Only: The salary range for this role is $104,700 to $190,400 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.