Acute Coding Subject Matter Expert (SME)

Optum Insight is improving the flow of health data and information to create a more connected system. We remove friction and drive alignment between care providers and payers, and ultimately consumers. Our deep expertise in the industry and innovative technology empower us to help organizations reduce costs while improving risk management, quality and revenue growth. Ready to help us deliver results that improve lives? Join us to start Caring. Connecting. Growing together. 

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 solid 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, Client, and Coding Operations to monitor day to day coding operations, complete 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 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:

• High School Diploma/GED
• Current, active coding credential through AAPC or AHIMA
• 5+ years as a subject matter expert in corporate coding leadership role for large multi-site healthcare organizations, both internal and contract as well as remote and/or domestic and global
• 5+ years of experience in coding reviewer role auditing Inpatient and/or Outpatient accounts
• 5+ years of experience working collaboratively with CDI and Quality leadership in partnership to improve reimbursement and coding accuracy
• 5+ years of experience with computer assisted coding technologies and EMR (Electronic Medical Record) coding workflow
• Intermediate level of proficiency with: Microsoft Excel (specifically managing large data sets)
• Intermediate level of proficiency with PowerPoint (specifically creating and presenting for the purpose of training a variety of different audiences)

Preferred Qualifications:        

• Experience with Cloudmed
• Operational knowledge of health care related to 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 exemplary level ability to influence change and serve as primary change agent
• 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
• Proven personal presence that is characterized by a sense of honesty, integrity, and caring with the ability to inspire and motivate others to promote the philosophy, mission, vision, goals, and values of Optum360 and our client organization(s)

*All Telecommuters 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 $72,800 to $130,000 annually based on full-time employment. We comply with all minimum wage laws as applicable.

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records. 

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.

#RPO #GREEN