SIU Coding Consultant Manager - OptumInsight - Telecommute

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timePosted 8 days ago location United States salarySalary undisclosed
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Job Description

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.(sm)

This leadership position will lead and drive strategic direction for a team within Fraud and Abuse. Whether leading a region or a team of coding consultants, the leader oversees multi-level staff and processes across multiple lines of business, and multiple claim platforms. In addition, the candidate will work closely with external law enforcement officials, internal and external legal or compliance partners on escalated investigations or issues. Day to day management includes employee development, expense management, project management, client management / implementation, business process enhancement and short- and long-term strategy for business growth and expansion, day to day KPI's and ensuring we meet and/or exceed performance metrics. This position supports, manages and escalates identification of additional suspected fraud of health insurance claims and ensures claims are accurately handled. This team member will also be responsible for providing operational support in reporting, process improvements, coaching, internal quality, and special projects.

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

Primary Responsibilities:

  • Provide leadership to 15-20 prepay coding consultant investigators and is accountable for tracking KPI's, metrics, OT, TAT etc., provides feedback to staff on performance, sets direction, resolves problems, provides guidance to team members when needed and takes necessary steps to address poor performance including corrective action up to termination
  • Create, implement and improve operational changes through documentation and process flows that anticipate customer needs and help in development of solutions to ensure all client needs and issues are addressed promptly
  • Work with multiple clients and levels within those clients and matrix partners (legal, UHC PI, United SIU, appeals etc.) and serves as the key resource on complex and critical issues
  • Provide input to forecasting and planning activities for future state of the business staffing needs, adapts department plans and priorities based on operational needs of the business
  • Direct team members in the area of ideation and vetting new concepts for building additional investigation opportunities or clearer review guidelines for cases
  • Partner with the client to make new policy or edits to mitigate fraudulent behavior
  • Work with Law Enforcement and Government and Case Affairs to appropriately support federal and state investigations or provide expert testimony during court proceedings
  • Drive process improvement and automation initiatives to enhance quality and productivity of outputs

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:

  • Licensed registered nurse (RN) or Licensed Practical Nurse (LPN) with 3+ years of nursing and coding experience OR Certified Professional Coder (CPC) with 3+ years of coding (in a surgical, hospital, and or clinic setting)
  • 2+ years of recent experience in a direct people manager role
  • 1+ year of health insurance experience
  • If you need to enter a work site for any reason, you will be required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or similar UnitedHealth Group-approved symptom screener. When in a UnitedHealth Group building, employees are required to wear a mask in common areas. In addition, employees must comply with any state and local masking orders

Preferred Qualifications:

  • Undergraduate degree
  • Experience managing multiple projects / initiatives and drive to completion
  • Intermediate knowledge of MS Excel, Word, PowerPoint, SharePoint
  • Basic knowledge of MS Visio
  • Experience with metrics and performance, reporting, and understanding of trends and changes
  • Experience in healthcare claim investigations
  • Lean and or Six Sigma Methodology

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)

Colorado Residents Only: The salary range for Colorado residents is $79,700 to $142,600. Pay is based on several factors including but not limited to education, work experience, certifications, etc. As of the date of this posting, In addition to your salary, UHG offers the following benefits for this position, subject to applicable eligibility requirements: Health, dental, and vision plans; wellness program; flexible spending accounts; paid parking or public transportation costs; 401(k) retirement plan; employee stock purchase plan; life insurance, short-term disability insurance, and long-term disability insurance; business travel accident insurance; Employee Assistance Program; PTO; and employee-paid critical illness and accident insurance.

*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.


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.


Keywords: coding, consultant, manager, telecommute, remote, work from home