Manager Quality Assurance Texas

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 beenefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

This position will report into the Associate Director of Quality Assurance and is responsible for the oversight, strategy and daily activities of the Quality Assurance Auditors. Will also assist with Optum Care Delivery’s Internal Medicare Advantage Quality Review program, various coding QA projects, and high level confidential audit projects as needed. This is a national role, requiring interaction with all markets and/or business units within Care Delivery and Home and Community.  

If you are located in Texas, you will have the flexibility to work remotely* as you take on some tough challenges.

Primary Responsibilities:

• Provides oversight and coordination of staff assignments for the Quality Assurance Auditors
  • Span of Control: 5-10 direct reports 
• Conducts technical training and onboarding of new employees
• Completes one-on-one meetings/coaching sessions with direct reports on a minimum monthly basis
• Clearly communicates goals, standards and needs of the department and organization
• Ensures that Optum Policies and coding standards are consistently applied in all processes
• Ensure that all Auditors meet education, quality and productivity standards
• Provides input and feedback on employee performance and conducts counseling and disciplinary actions as necessary
• Performs third level review (QA3) on coding results, making final decision on discrepancies between coding/auditing staff, for internal Care Delivery or Home & Community coding teams or contracted vendors, ensuring Quality Assurance Auditors and Senior Auditors are auditing in accordance with guidelines
• Will lead QA project for assigned market, ensuring deadlines are met and escalate any areas of concern to QA Leadership as necessary  o Develops relationships with Coding Teams; ensure QA Findings are distributed on regular weekly cadence; respond to QA Findings disputes in a timely manner (within 3 business days); communicates guidelines, updates, and requirements to ensure correct coding 
  • Provide direction and review QA findings with assigned Quality Assurance Auditors; provide coaching and mentorship as needed
• Acts as resource for coding questions and issues
• Onboarding and training of new Quality Assurance Auditors and Senior Auditors as needed
• SME for Optum Coding Guidelines; ensure Optum Coding Guidelines and Compliance Policies are consistently applied in all processes
• Perform higher level compliance and other ad-hoc audits as needed
• Seeks ways to improve operational efficiency and make process improvement recommendations
• Collaborate with senior management to develop and revise training material based on QA results
• Must be able to work with multiple coding tools and EMR systems
• Cross-functional collaboration with multiple teams 
• Perform all other related duties as assigned

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:

• Undergraduate degree or equivalent years’ experience
• AHIMA or AAPC Credentialed Coder (CPC, COC, CCS, CCS-P or RHIT)
• 6+ years of experience ICD-10-CM coding with expert knowledge of ICD-10-CM guidelines  
• 4+ years of experience HCC coding with advanced knowledge of Medicare Risk Adjustment
• 4+ years of experience in an auditor role, providing feedback to coders or vendors on coding accuracy results
• 2+ years of management/supervisory experience or in a Quality Assurance Project Lead position (internal)
• Proficient experience working with various EMR and Coding Tool Software
• Expert knowledge of Optum Coding Guidelines
• Proven ability to interact with multiple levels of management including, clients, vendors, and healthcare providers
• Proven ability to work during standard business hours, with flexibility to accommodate meetings in various time zones when needed
• Proven to be self-motivated; ability to work independently in a fast-paced environment with minimal supervision and guidance required to meet deadlines
• Ability to continuously meet the requirements for a telecommuter, i.e. live in a location that can receive a UnitedHealth Group approved high speed internet connection, smartphone for Multi Factor Authentication (MFA) purposes, have a secure designated office space to maintain PHI, meet or exceed all performance expectations

Preferred Qualifications:

• CRC (Certified Risk Coder) in addition to required coding certification
• 1+ years Project Lead within Risk & Value Operations Quality Assurance team
• Experience with WebEx or similar virtual meeting tools
• Experience using diagnosis coding data and trends to identify training opportunities HEDIS/STARS knowledge
• Microsoft Office proficiency (Word, Excel, PowerPoint & Outlook)
• Proven excellent organizational, problem solving, and critical thinking skills
• Proven excellent verbal/written communication and interpersonal skills

*All employees working remotely will be required to adhere to UnitedHealth 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 $89,900 to $160,600 annually based on full-time employment. We comply with all minimum wage laws as applicable.

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.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. 

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