Director, Compliance - FFS Coding - Remote

UnitedHealth Group•Eden Prairie, MN

3d•$134,600 - $230,800•Remote

About The Position

The Director, Compliance – FFS Coding is a strategic leadership role within Optum Coding Compliance, providing fee-for-service (FFS) coding expertise across inpatient, outpatient facility, and professional services coding. This role also provides compliance guidance to Optum FFS coding teams, including Optum Insight clients. This position will lead Optum-wide FFS coding compliance processes, including oversight of the OI Provider QA process, support for offshoring implementations and contractual obligations, execution of risk-based audits of OH employed providers, coders, OI coders and vendors, and monitoring of new or updated coding guidelines. The role will also support training for Optum coding teams and clients. This position reports to the VP, Optum Coding Compliance, and will partner closely with 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.

Requirements

CCS, CPC, RHIT or similar coding certification
10+ years of experience with increasing responsibility for FFS coding or related compliance functions with proven history of successful results in managing functional compliance
Proven experience with auditing, monitoring and provider education
Experience with compliance software, EMR systems and coding platforms
Experience working with senior executives
Deep understanding of outpatient, inpatient and specialty coding, CMS regulations, NCD and LCD guidelines, DRG methodologies
Solid communication skills and business acumen
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
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
Objective, collaborative approach. Ability to adapt in a dynamic and high-growth environment
Familiarity with health plan benefits operations
All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

Responsibilities

Drive compliance strategy for the FFS-related components of the Optum Coding Compliance program; collaborate with enterprise compliance and business partners to implement that strategy
Design and execute a risk-based FFS audit plan to supplement business quality assurance processes. Drive remediation of issues identified through compliance-led audits, including oversight and tracking of remediation derived from quality assurance processes
Manage coding compliance professionals supporting the Optum Coding Compliance program; provide FFS coding expertise to support other members of the Optum business compliance and legal teams
Engage with stakeholders at all levels of the organization and evaluate critical processes related to FFS coding compliance
Administer program oversight and collaborate with business leaders and teams to support ongoing reviews, implementation of requirements, and corrective action, as necessary
Establish and maintain routine oversight standards and make recommendations for operational improvements
Contribute, as needed, to Optum-level FFS coding compliance training and education, policies, and communications to promote compliance with applicable laws and coding standards
Collaborate with business, operations, and other functional compliance areas to review, analyze, and develop or oversee implementation projects to ensure compliance with new FFS coding standards, requirements, or audit execution
Report FFS coding compliance activities to management and ensure effective management of oversight activities