At Optum, we are committed to transforming healthcare through innovative technology, enabling countless individuals to lead healthier lives. By joining our dynamic team, your contributions will directly enhance health outcomes, ensuring that people are connected with vital care, pharmacy benefits, data, and resources. Here, you will thrive in a culture that emphasizes diversity and inclusion, supported by talented colleagues, extensive benefits, and rich opportunities for career growth. Together, let’s make a significant impact in the communities we serve and work towards advancing health equity on a global scale. Join us and experience a journey of Caring. Connecting. Growing together.

As an Auditor specializing in Acute and Profee Surgical coding, you will serve as a Subject Matter Expert in Surgical CPT coding. Your key responsibilities will include auditing and providing educational support to both providers and coders within the Middle Revenue Cycle Coding Services Operational Team, emphasizing CPT coding, ICD-10-CM classification, Modifier assignment, and adherence to Official Coding Guidelines. You will play a crucial role in auditing acute and professional CPT code settings, guiding key surgical coding concepts while keeping providers and coders informed about the latest regulations, coding guidelines, and payor requirements.

This role requires oversight of Optum360 coding services, where you will lead operations within facility-based and/or Health Information Management (HIM) Center departments throughout your assigned region. Your leadership will extend to driving key initiatives related to Quality metrics, workflow enhancements, audits, and more, all aimed at surpassing performance metrics, driving efficiency, and standardizing processes to promote best practices across facilities. As an integral part of the Optum360 HIM/Coding Operations team, you will engage in client-facing meetings with Quality Teams, Clinical Documentation Improvement (CDI) specialists, and others, focusing on prebill reviews and related accounts such as HAC/PSIs. You will spearhead continuous quality improvements, diligently tracking, monitoring, and analyzing performance to meet business objectives while exceeding Service Level Agreement commitments. Building and maintaining robust client relationships and embodying Optum360’s values are essential components of this position.

Enjoy the flexibility of remote work from anywhere in the U.S., as you tackle rewarding challenges.

Key Responsibilities:

• Sustain and exemplify expert knowledge of coding operations and best practices, driving the integration of Optum360 business objectives in the client environment.
• Identify opportunities and build consensus for standardizing systems and processes, implementing best practices, and enhancing communication related to key coding operations:
  • Facilitates the integration of Optum360 coding functions within the served facilities.
  • Utilizes established processes and systems to minimize waste and costs while enhancing SLAs, KPIs, metrics, and the overall client and patient experience.
• Collaboratively monitor daily coding operations, prebill coding reviews, and quality assessments alongside HIM, CDI, and Coding Operations teams.
• Support Coding Leadership in overseeing initiatives designed for continuous improvement of coding quality and efficiency.
• Maintain expert knowledge in coding to achieve high accuracy and meet or exceed performance standards.
• Lead and engage in coding quality assurance and compliance activities, including action plans for audit results and mentoring around corrective measures.
• Act as a liaison among coding operations, fostering cohesive relationships with clients and stakeholders.
• Utilize provided tools and data to enhance engagement among unions, clients, and employees, driving initiatives towards higher employee satisfaction.
• Model effective leadership; promote teamwork and cultivate a positive, transparent work environment that maximizes results.
• Participate in leadership forums and lead informational/educational sessions for designated HIM/Coding/CDI managers.
• Drive operational success by:
  • Promoting cooperation among business and clinical stakeholders.
  • Providing training and mentoring for staff.
  • Offering constructive feedback aimed at enhancing accuracy.
  • Recognizing and rewarding performance during common review processes.
  • Fostering innovation and staff development to boost engagement and satisfaction.
• Perform other duties as assigned by Optum360 leadership, including leading special projects, developing work plans, facilitating resource allocation, and collaborating with various departments as necessary.
• Serve as a Subject Matter Expert on relevant Federal, State, and local regulations, ensuring compliance with Optum360’s integrity program and standards of conduct, while nurturing a service-oriented culture within the organization.

Experience a work environment where your efforts are valued and recognized, with clear guidance on what it takes to thrive in your role as well as opportunities for development across various career paths.

Required Qualifications:

• Valid AAPC or AHIMA coding credential (CCS, CPC, RHIT, or RHIA).
• 5+ years of recent experience in OP coding and/or as a coding reviewer.
• Proven experience collaborating with CDI and Quality leadership to boost coding accuracy and reimbursement.
• Familiarity with computer-assisted coding technologies and EMR coding workflows.
• Proficiency in Microsoft Excel, Word, PowerPoint, and SharePoint.
• Valid Driver’s License and reliable transportation access.

Preferred Qualifications:

• Auditing experience in cardiothoracic, neuro, ophthalmic, oral, maxillofacial, spine, trauma, hematology, oncology, plastic, and vascular coding.
• In-depth operational knowledge of healthcare related Federal and State regulations, along with standards from oversight agencies and accrediting bodies (e.g., CMS, TJC).
• Exceptional organizational skills, including multitasking and managing multiple projects with rapid turnaround.
• Proven ability to engage effectively with individuals at executive, managerial, and staff levels.

All remote employees must comply with UnitedHealth Group’s Telecommuter Policy.

The hourly compensation for this role ranges from $28.61 to $56.06, depending on full-time employment, local labor markets, and various factors such as education, work experience, and certifications. UnitedHealth Group adheres to applicable minimum wage laws. Besides your salary, you will enjoy a comprehensive benefits package, performance-based incentives, stock purchasing options, and 401k contributions (subject to eligibility requirements). No matter where you embark on your journey with UnitedHealth Group, a broad array of benefits and incentives awaits you.

Application Deadline: This position will be open for a minimum of 2 business days or until we gather a sufficient candidate pool. The posting may close earlier based on applicant volume.

At UnitedHealth Group, our mission is to enable healthier lives and enhance the effectiveness of the health system for all. We believe that every person, irrespective of race, gender, sexuality, age, location, or income, deserves an opportunity to achieve optimal health. However, substantial barriers to good health persist, disproportionately affecting marginalized groups and those with lower incomes. We are dedicated to reducing our environmental impact and providing equitable care that addresses health disparities and improves outcomes—principles reflected in our mission.

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