Director - Risk Adjustment

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 role will be responsible for ensuring the governance, monitoring, and end-to-end controls of Optum Health's Risk Adjustment tools impacting market risk adjustment operational improvement such as Epic, DataCore, and Care Data Platform.  It is responsible for managing risk adjustment elements such as suspect generation throughput, roster management to work queue assignments, gap presentation issues, and diagnosis code workflow from Optum Health centralized data platforms to the clinical tools to the point of patient encounter within the local markets through CMS submission including tracking the diagnosis codes through all clinical and revenue cycle systems and implementing controls.  This role will impact the accuracy and completeness of CMS risk adjustment payment by ensuring that all data is appropriately handled and submitted.

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.

Risk Adjustment Data Collection and Submission:

• Assess and perform gap assessments on the Risk adjustment tools and workflows to document and enhance the business requirements and framework to ensure accurate and complete risk adjustment diagnosis code presentation, collection and submission
• Diagnose process improvement opportunities and develop solutions using principles of process excellence and related tools to create stable and scalable risk adjustment diagnosis code data collection processes at the local market level through CMS submission
• Ensure that business requirements to transfer or extract risk adjustment diagnosis codes are productionalized and operating as designed
• Analyze and track risk adjustment diagnosis codes transfer through multiple stakeholder groups that add, delete or modify the risk adjustment code.  Ensure that the accurate final state of the risk adjustment diagnosis code is submitted to CMS
• Monitor and oversight risk adjustment diagnosis code collection and submission controls to both prevent and detect data leakage or incorrect data transformation
• Collaborating with cross-functional teams including corporate and local stakeholders to resolve or proactively mitigate potential risk adjustment data leakage
• Prevent or detect risk adjustment data leakage by monitoring key performance indicators and taking action as appropriate including legal and compliance activities
• Forensically analyze prior risk adjustment diagnosis code submissions to identify potential inaccurate data submissions.  Implement remediation plans as necessary
• Reconcile known local risk adjustment diagnosis code data sources and validate their presence in CMS response files.  If not present, forensically identify valid reasons for the non-submission

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 risk adjustment managed care experience
• Technical experience in Microsoft programs such as excel

*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 $134,600 to $230,800 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.