UnitedHealth Group Manager Quality Assurance - Telecommute in Las Vegas, Nevada
Enterprise Clinical Performance is charged with effectively implementing, monitoring, and executing on government pay for performance programs with a special focus on Risk Adjustment and HEDIS. Clinical Performance processes on a national level by providing support in all markets served by OptumCare Care Delivery. This position will report into the Director of Compliance and Quality Assurance and will be responsible for the oversight, strategy and daily activities of the Quality Assurance Auditors. Will also assist with OptumCare Delivery's Internal Medicare Advantage Quality Review program, Vendor coding QA, second level review programs, and high level confidential audit projects as needed. This is a national role, requiring interaction with all markets and/or business units within Care Delivery and Care Services.
You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
Manage all aspects of the Quality Assurance Program on a national level:
Provides oversight and coordination of staff assignments for the Quality Assurance Auditors
Conducts technical training and onboarding of new employees
Schedules and completes weekly one-on-one meetings/coaching sessions with direct reports
Performs second level quality audits on Senior Auditors on a monthly basis
Clearly communicates goals, standards and needs of the department and organization
Ensures that Optum Policies and coding standards are consistently applied in all processes
Ensure that all Auditors meet education, quality and productivity standards
Provides input and feedback on employee performance and conducts counseling and disciplinary actions as necessary
Provides guidance and support related to CMS regulations and Optum Coding Guidelines
Seeks ways to improve operational efficiency and make process improvement recommendations
Must be able to drive Coding Compliance Initiatives across all markets within Care Delivery
Support efforts of Enterprise Clinical Performance in all other initiatives
Bachelor’s degree preferred or equivalent work experience may be substituted
CPC, CCS or RHIT certification required
7+ years’ experience ICD coding
2+ years’ experience Management/Supervisory role
4+ years’ experience in Risk Adjustment
5+ years’ experience in an auditor role, such as vendor QA or coder QA, providing feedback of audit results
Expert knowledge of CMS Risk Adjustment and ICD coding requirements and regulations
Proficient knowledge of HEDIS/Stars
Experience with retrospective and concurrent chart review programs for Medicare Advantage Enrollees
Ability to work a flexible schedule to accommodate meetings in multiple time zones. Standard business hours. Monday – Friday 8am -5pm.
Ability to interact with multiple levels of management including, clients, vendors, and healthcare providers
Must be able to continuously meet the requirements for a telecommuter, i.e. live in a location that can receive a UnitedHealth Group approved high speed internet connection, have a secure designated office space to maintain PHI, meet or exceed all performance expectations
Up to 25% travel required ( local and national travel)
5+ years’ provider education/query experience
COE Senior Quality Assurance Auditor Experience
Demonstrated ability to exercise good judgment
Ability to prioritize tasks, multi-task, and solve problems under tight deadlines
Good written and oral communication and presentation skills and be able to communicate complex issues
Proficiency with Microsoft Office
Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system 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
*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.
Job Keywords: CPC, CCS, CCS-P, RHIT, CRC, auditor, risk adjustment, HCC, HEDIS, STARS, Coder, UHG, Optum, Quality Assurance, Telecommute, remote