Director - Risk Adjustment

UnitedHealth Group•Brentwood, TN

15h•$134,600 - $230,800•Remote

About The Position

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.

Requirements

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.
Candidates are required to pass a drug test before beginning employment.

Responsibilities

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