Sr. Director, Compliance - Risk Adjustment Coding

UnitedHealth Group • Eden Prairie, MN

75d • $156,400 - $268,000

About The Position

This position is an impactful and strategic role for Optum compliance, providing risk adjustment coding expertise to the Optum Coding Compliance program and strategic guidance and support to all Optum risk adjustment coding business unit teams. The Sr. Director Compliance - Risk Adjustment Coding is accountable for the for the Optum-wide risk-adjustment coding compliance program, including leading RA coding policy development and governance, risk-based compliance auditing, and remediation of identified issues. This position reports to the VP, Optum Coding Compliance and will partner closely with the other Optum and enterprise compliance leaders, as well as key clinical, operational, business and legal partners.

Requirements

• CRC, CCS, RHIT or similar coding certification
• 5+ years of experience with increasing responsibility for risk adjustment coding or related compliance functions with proven history of successful results in managing functional compliance
• Deep understanding of HCC coding, CMS regulations particularly Medicare and Medicare Advantage plans and risk adjustment methodologies
• Experience with value-based programs, HEDIS and other quality improvement programs
• Proven experience with audits, retrospective reviews, and provider education
• Experience with compliance software, EMR systems and coding platforms
• Solid communication skills and business acumen
• Experience working with senior executives
• 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
• Familiarity with health plan benefits operations

Nice To Haves

• 10+ years of relevant compliance and regulatory experience
• 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
• Objective, collaborative approach. Ability to adapt in a dynamic and high-growth environment

Responsibilities

• Drive compliance strategy for the risk adjustment related components of the Optum Coding Compliance Program; collaborate with enterprise compliance and business partners on implementing that strategy
• Manage coding compliance professionals supporting the Optum Compliance Coding program; provide risk adjustment coding expertise to support other members of the Optum business compliance and legal teams
• Design and execute a risk-based risk adjustment audit plan to supplement business quality assurance processes. Drive remediation of issues identified from compliance led audits including oversight and tracking of remediation derived from quality assurance processes
• Evaluate critical processes; administer risk adjustment coding oversight for compliance; collaborate with the business leaders and business teams to ensure ongoing reviews, implementation of requirements, and corrective action as necessary
• Establish and maintain routine oversight standards; make recommendations for operational improvements; report risk adjustment coding compliance activities to management
• Ensure effective management of risk adjustment coding compliance oversight activities
• Develop, implement, and update as needed Optum level risk adjustment coding compliance standards and policies to promote compliance with applicable laws and coding standards
• Oversee and review risk adjustment operational coding policies and procedures as needed
• Develop, implement, and update as necessary risk adjustment coding compliance training, awareness and educational materials and programs
• Support investigation of reported or suspected incidents of non-compliance and ensure appropriate remediation and consistent disciplinary guidelines are enforced for confirmed incidents of noncompliance
• Conduct acquisition due diligence and manage compliance integration of acquired entities for risk adjustment coding compliance integration
• Provide subject matter expertise for compliance investigations, assessments, audits and reviews
• Proactively track and provide expertise on new or updated regulatory changes with risk adjustment coding and enforcement
• Support risk adjustment coding compliance remediation and corrective action plans, resulting from audits, investigations, compliance reviews, and self-identified issues
• Collaborate with business, operations and other functional areas to review, analyze and develop/oversee implementation project plans to ensure compliance with new risk adjustment coding standards or requirements

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Industry: Insurance Carriers and Related Activities
• Education Level: Bachelor's degree
• Number of Employees: 5,001-10,000 employees