The Director, Compliance - FFS Coding is a strategic leadership role within Optum Coding Compliance, providing fee-for-service (FFS) coding expertise across inpatient, outpatient facility, and professional services coding. This role also provides compliance guidance to Optum FFS coding teams, including Optum Insight clients.
This position will lead Optum-wide FFS coding compliance processes, including oversight of the OI Provider QA process, support for offshoring implementations and contractual obligations, execution of risk-based audits of OH employed providers, coders, OI coders and vendors, and monitoring of new or updated coding guidelines. The role will also support training for Optum coding teams and clients. This position reports to the VP, Optum Coding Compliance, and will partner closely with 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 FFS-related components of the Optum Coding Compliance program; collaborate with enterprise compliance and business partners to implement that strategy
- Design and execute a risk-based FFS audit plan to supplement business quality assurance processes. Drive remediation of issues identified through compliance-led audits, including oversight and tracking of remediation derived from quality assurance processes
- Manage coding compliance professionals supporting the Optum Coding Compliance program; provide FFS coding expertise to support other members of the Optum business compliance and legal teams
- Engage with stakeholders at all levels of the organization and evaluate critical processes related to FFS coding compliance
- Administer program oversight and collaborate with business leaders and teams to support ongoing reviews, implementation of requirements, and corrective action, as necessary
- Establish and maintain routine oversight standards and make recommendations for operational improvements
- Contribute, as needed, to Optum-level FFS coding compliance training and education, policies, and communications to promote compliance with applicable laws and coding standards
- Collaborate with business, operations, and other functional compliance areas to review, analyze, and develop or oversee implementation projects to ensure compliance with new FFS coding standards, requirements, or audit execution
- Report FFS coding compliance activities to management and ensure effective management of oversight activities
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:- CCS, CPC, RHIT or similar coding certification
- 10+ years of experience with increasing responsibility for FFS coding or related compliance functions with proven history of successful results in managing functional compliance
- Proven experience with auditing, monitoring and provider education
- Experience with compliance software, EMR systems and coding platforms
- Experience working with senior executives
- Deep understanding of outpatient, inpatient and specialty coding, CMS regulations, NCD and LCD guidelines, DRG methodologies
- Solid communication skills and business acumen
- 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
- 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
- Objective, collaborative approach. Ability to adapt in a dynamic and high-growth environment
- Familiarity with health plan benefits operations
*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy.
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). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $134,600 - $230,800 annually based on full-time employment. We comply with all minimum wage laws as applicable.
Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
