Sr. Director, Compliance – Risk Adjustment Coding

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 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 is an impactful and strategic role for Optum compliance, providing risk adjustment coding  expertise to the Optum Coding Compliance program and strategic guidance and support to all Optum risk adjustment coding business unit teams. The Sr. Director Compliance – Risk Adjustment Coding is accountable for the for the Optum-wide risk-adjustment coding compliance program, including leading RA coding policy development and governance, risk-based compliance auditing, and remediation of identified issues.   This position reports to the VP, Optum Coding Compliance and will partner closely with the other Optum and enterprise compliance leaders, as well as key clinical, operational, business and legal partners.  

 

You’ll enjoy the flexibility to work remotely* from anywhere within the U.S. as you take on some tough challenges. For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week.

 

Primary Responsibilities:

• Drive compliance strategy for the risk adjustment related components of the Optum Coding Compliance Program;  collaborate with enterprise compliance and business partners on implementing that strategy
• Manage coding compliance professionals supporting the Optum Compliance Coding program; provide risk adjustment coding expertise to support other members of the Optum business compliance and legal teams
• Design and execute a risk-based risk adjustment audit plan to supplement business quality assurance processes.  Drive remediation of issues identified from compliance led audits including oversight and tracking of remediation derived from quality assurance processes
• The position will have exposure to all levels of the organization, will evaluate critical processes; administer risk adjustment coding oversight for compliance; collaborate with the business leaders and business teams to ensure ongoing reviews, implementation of requirements, and corrective action as necessary; establish and maintain routine oversight standards; make recommendations for operational improvements; report risk adjustment coding compliance activities to management; and ensure effective management of risk adjustment coding compliance oversight activities
• Lead compliance’s risk adjustment risk coding compliance function within the framework of the overall Optum compliance program, including:
  • Develop, implement, and update as needed Optum level risk adjustment coding compliance standards and policies to promote compliance with applicable laws and coding standards  
  • Oversee and review risk adjustment operational coding policies and procedures as needed
  • Develop, implement, and update as necessary risk adjustment coding compliance training, awareness and educational materials and programs 
  • Support investigation of reported or suspected incidents of non-compliance and ensure appropriate remediation and consistent disciplinary guidelines are enforced for confirmed incidents of noncompliance
  • Conduct acquisition due diligence and manage compliance integration of acquired entities for risk adjustment coding compliance integration
  • Provide subject matter expertise for compliance investigations, assessments, audits and reviews
  • Proactively track and provide expertise on new or updated regulatory changes with risk adjustment coding and enforcement
• Support risk adjustment coding compliance remediation and corrective action plans, resulting from audits, investigations, compliance reviews, and self-identified issues
• Collaborate with business, operations and other functional areas to review, analyze and develop/oversee implementation project plans to ensure compliance with new risk adjustment coding standards or requirements

 

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:

• CRC, CCS, RHIT or similar coding certification
• 5+ years of experience with increasing responsibility for risk adjustment coding or related compliance functions with proven history of successful results in managing functional compliance
• Deep understanding of HCC coding, CMS regulations particularly Medicare and Medicare Advantage plans and risk adjustment methodologies 
• Experience with value-based programs, HEDIS and other quality improvement programs
• Proven experience with audits, retrospective reviews, and provider education
• Experience with compliance software, EMR systems and coding platforms 
• Solid communication skills and business acumen
• Experience working with senior executives
• Knowledge of risk management methodologies and tools, including ability to identify and manage resources
• Demonstrated ability to lead and influence in a large, matrixed organization
• Proven ability to drive cross-functional teams to deliver operational compliance
• Familiarity with health plan benefits operations

 

Preferred Qualifications:

• 10+ years of relevant compliance and regulatory experience
• Self-starter with proven track record of driving results in heavily matrixed environment 
• Collaborative, innovative, accountable and agile team leader
• Excellent strategic decision-making, analytic, influence and communication (written and verbal) skills
• Objective, collaborative approach. Ability to adapt in a dynamic and high-growth environment

 

*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 $156,400 to $268,000 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.