Talent.com
Sr. Director, Compliance - Risk Adjustment Coding

Sr. Director, Compliance - Risk Adjustment Coding

UnitedHealth GroupCircle Pines, MN, US
10 hours ago
Job type
  • Full-time
Job description

Sr. Director Compliance - Risk Adjustment Coding

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 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.

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.

Primary 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
  • The position will have exposure to all levels of the organization, will 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; and ensure effective management of risk adjustment coding compliance oversight activities
  • Lead compliance's risk adjustment risk coding compliance function within the framework of the overall Optum compliance program, including :
  • 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
  • You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

    Required Qualifications :

  • 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
  • Preferred Qualifications :

  • 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
  • Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary for this role will range from $156,400 to $268,000 annually based on full-time employment. We comply with all minimum wage laws as applicable.

    Create a job alert for this search

    Director Compliance • Circle Pines, MN, US

    Related jobs
    • Promoted
    Licensed Therapist - LICSW-LPCC-LMFT

    Licensed Therapist - LICSW-LPCC-LMFT

    LifeStance HealthWelch, MN, US
    Full-time +1
    At LifeStance Health, we believe in a truly healthy society where mental and physical healthcare are unified to make lives better. Our mission is to help people lead healthier, more fulfilling lives...Show moreLast updated: 11 days ago
    • Promoted
    Sr. Associate Counsel - Regulator Risk and Compliance

    Sr. Associate Counsel - Regulator Risk and Compliance

    MarvinEagan, MN, United States
    Full-time
    Associate Counsel - Regulator Risk and Compliance.We're looking for a thoughtful and experienced attorney to help guide our teams through the complex world of regulations and compliance.This role p...Show moreLast updated: 10 days ago
    • Promoted
    Hospice Director, RN

    Hospice Director, RN

    Interim HealthCare of the Twin CitiesRosemount, MN, United States
    Full-time +1
    Work with our amazing Hospice staff to provide efficient and effective delivery of hospice care to our patients.Helps to ensure the Hospice program meets standards of quality and contributes to the...Show moreLast updated: 4 days ago
    • Promoted
    Director Crop Insurance

    Director Crop Insurance

    Compeer FinancialLakeville, MN, United States
    Full-time
    Compeer Financial is a member-owned cooperative located in Illinois, Minnesota and Wisconsin.We bring together team members with a variety of backgrounds and experiences to help provide financial s...Show moreLast updated: 30+ days ago
    • Promoted
    Director, Claim Pricing - Remote

    Director, Claim Pricing - Remote

    UnitedHealth GroupMinnetonka, MN, United States
    Remote
    Full-time
    At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people ...Show moreLast updated: 30+ days ago
    • Promoted
    Security Lead

    Security Lead

    VirtualVocationsSaint Paul, Minnesota, United States
    Full-time
    A company is looking for a Security Lead to build and manage its security function across governance, engineering, and operations. Key Responsibilities Own the company's security posture from code...Show moreLast updated: 30+ days ago
    • Promoted
    • New!
    Travel Echo Tech - $2,102 to $2,330 per week in Red Wing, MN

    Travel Echo Tech - $2,102 to $2,330 per week in Red Wing, MN

    AlliedTravelCareersRed Wing, MN, US
    Full-time
    AlliedTravelCareers is working with LRS Healthcare to find a qualified Echo Tech in Red Wing, Minnesota, 55066!.Ready to start your next travel adventure? LRS Healthcare offers a full benefits pack...Show moreLast updated: 17 hours ago
    • Promoted
    Director Compensation

    Director Compensation

    Compeer FinancialLakeville, MN, United States
    Full-time
    Compeer Financial is a member-owned cooperative located in Illinois, Minnesota and Wisconsin.We bring together team members with a variety of backgrounds and experiences to help provide financial s...Show moreLast updated: 24 days ago
    • Promoted
    Outside Insurance Sales - Completed Training Required

    Outside Insurance Sales - Completed Training Required

    Platinum Supplemental InsuranceCoon Rapids, Minnesota
    Full-time
    Ready to jump-start your career and take charge of your earning potential?.At Platinum Supplemental Insurance, we’re looking for motivated individuals ready to learn, grow, and thrive in a fast-pac...Show moreLast updated: 30+ days ago
    • Promoted
    Senior Director, Treasury Capital Markets - Remote

    Senior Director, Treasury Capital Markets - Remote

    UnitedHealth GroupEden Prairie, MN, United States
    Remote
    Full-time
    UnitedHealth Group is a health care and well-being company that's dedicated to improving the health outcomes of millions around the world. We are comprised of two distinct and complementary business...Show moreLast updated: 22 days ago
    • Promoted
    Sr. Sustaining Quality Engineer

    Sr. Sustaining Quality Engineer

    VelosityForest Lake, MN, United States
    Permanent
    Sustaining Quality Engineer to support our manufacturing facility in Forest Lake, MN.Sustaining Quality Engineer is responsible for supporting production through engineering change protocols, produ...Show moreLast updated: 30+ days ago
    • Promoted
    • New!
    Healthcare Compliance Auditor

    Healthcare Compliance Auditor

    VirtualVocationsSaint Paul, Minnesota, United States
    Full-time
    A company is looking for a Healthcare Compliance Auditor - Enterprise Risk.Key Responsibilities Assist in reviewing coding, billing, and claims processing policies to develop compliance monitors ...Show moreLast updated: 5 hours ago
    • Promoted
    Prin Internal Credit Reviewer

    Prin Internal Credit Reviewer

    Compeer FinancialLakeville, MN, United States
    Full-time
    Compeer Financial is a member-owned cooperative located in Illinois, Minnesota and Wisconsin.We bring together team members with a variety of backgrounds and experiences to help provide financial s...Show moreLast updated: 30+ days ago
    • Promoted
    Project Safety Manager

    Project Safety Manager

    Ames Construction, Inc.Rosemount, MN, United States
    Full-time
    Ames Construction has built America for more than 60 years, and the exceptional people who make up our team are a vital factor in our success. We are a full-service, heavy civil and industrial gener...Show moreLast updated: 30+ days ago
    • Promoted
    Managing Veterinarian / Medical Director

    Managing Veterinarian / Medical Director

    National Veterinary AssociatesISANTI, Minnesota, United States
    Permanent
    Lead, Mentor, and Grow with Us.Francis Veterinary Clinic | Isanti, MN.Francis Veterinary Clinic is growing fast, and we’re ready to welcome a. If you’re an experienced DVM ready to step into leaders...Show moreLast updated: 5 days ago
    • Promoted
    Travel Echo Tech - $2,408 per week in Red Wing, MN

    Travel Echo Tech - $2,408 per week in Red Wing, MN

    AlliedTravelCareersRed Wing, MN, US
    Full-time
    AlliedTravelCareers is working with Triage Staffing LLC to find a qualified Echo Tech in Red Wing, Minnesota, 55066!.Travel Radiology : Echo Ultrasound Red Wing, MN.Location : Red Wing, MN.Sh...Show moreLast updated: 1 day ago
    • Promoted
    Customs and Border Protection Officer

    Customs and Border Protection Officer

    U.S. Customs and Border ProtectionLindstrom, MN, United States
    Full-time
    Customs and Border Protection (CBP) offers those interested in a career in law enforcement an exceptional opportunity to work with an elite team of highly trained professionals whose camaraderie, p...Show moreLast updated: 30+ days ago
    • Promoted
    • New!
    Coating Operator Lead - $21 / hour

    Coating Operator Lead - $21 / hour

    Express EmploymentOsceola, WI, US
    Full-time
    Help a local dip molding company achieve its next level of success.Founded by a family in the 1960's, this company focuses on quality products. They take pride in the fact that they are a great ...Show moreLast updated: 18 hours ago