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  • Miami, FL

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Optum Risk Adjustment Quality Assurance Auditor- Telecommute

UnitedHealth Group • Miami, FL

Posted 11 days ago

Job Snapshot

Healthcare - Health Services
Health Care


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Job Description

For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us and help people live healthier lives while doing your life's best work.(sm)

This position’s major responsibility includes assistance in execution of a coding accuracy and improvement program across all markets. This includes OptumCare Delivery's Internal Medicare Advantage Quality Review program and Coding Vendor QA.  Will also assist with other second level review programs as needed. Must maintain compliance with Optum Coding Guidelines/policies and become a subject matter expert. This role will work with individual market leaders and other employees to ensure improvement in coding accuracy and various initiatives related to Risk Adjustment are implemented. Improvement will occur through internal and external education, innovative programs and provider engagement.   Perform all other related duties as assigned. The minimum productivity goal is set by project, with minimum 96% accuracy rate required.

**Work Schedule:  Monday - Friday, 8:00am - 5:00pm with the ability to work a flexible schedule to meet business needs and accommodate meetings in various time zones as needed.  Eastern or Central time zone strongly preferred. **

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

Primary Responsibilities:

  • Assist with execution of  Internal Risk Adjustment Coding Review programs
  • Performs quality audits on vendor charts as well as Care Delivery coding teams as needed
  • Provides support and assists Care Delivery with various coding initiatives as needed
  • Ensure that Optum Coding Guidelines are consistently applied in all processes
  • Identifies issues and trends in coding and documentation that affect provider risk adjustment factor scores
  • Provides input and valuable feedback on audit results
  • Provide ICD10-CM coding training, as it relates to HCC coding, as requested
  • Develops relationships with Care Delivery and communicates guidelines and requirements of Risk Adjustment Payment System to ensure correct coding and documentation
  • Cross-functional collaboration with multiple teams and functions

Required Qualifications:

  • Associates’ degree or higher (may consider certificate program/completed college coursework with equivalent experience for degree)
  • Coding Certification required (CPC, CCS, CCS-P, or RHIT;  CPC-A or CCA designation is not acceptable)
  • 5+ years of recent experience ICD - 9/10 coding, preferably in a Managed Care setting, with strong attention to detail and high accuracy rate
  • 2+ years of coding experience working in a provider’s office or for a Medicare Advantage health plan
  • 1+ years of recent experience in a coding auditor role
  • 2+ years of recent Medicare Risk Adjustment experience
  • 2+ years of Provider interaction - communicating directly with providers
  • Compliant Physician query experience / knowledge
  • Proficient knowledge of CMS-HCC model and guidelines
  • ICD-10-CM proficient
  • Knowledge of HEDIS / STARS
  • Up to 5% travel for local meetings for Florida residents only.
  • 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

Preferred Qualifications:

  • Bachelor’s degree
  • CRC (Certified Risk Coder) in addition to required coding certification
  • ICD-10-CM trainer
  • 1+ years HEDIS / STARS experience
  • Previous experience with WebEx or similar virtual meeting tools
  • Previous experience with data analysis and reporting
  • Previous experience using diagnosis coding data and trends to identify training opportunities

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

For more information on our Internal Job Posting Policy, click here.

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, or RHIT, coding, medicare, risk adjustment, east coast, ICD10, ICD9, audit, quality, CMS, HCC, CRC, Certified risk coder, telecommute, telecommuter, telecommuting

Job ID: 2551_752252
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