Job Description

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.

Primary Responsibilities:

Monitor quality activities to increase departmental accuracy and efficiency, including but not limited to planning, development, and implementation of improvement areas Review analysis of audit findings quality trends and noncompliance issues detected through auditing Collaborate with team supervisors to develop best practices for communicating areas of improvement Manage the implementation of proactive solutions to mitigate risk that will impact project quality Incorporate feedback from operational and QA reports to improve performance Assesses, evaluates, and addresses variance in production and key goals for operations Participates in team meetings/discussions of quality trends reported by team members Comply with the terms and conditions of the employment contract, company policies and procedures, and any and all directives (such as, but not limited to, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regard to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment). The Company may adopt, vary or rescind these policies and directives in its absolute discretion and without any limitation (implied or otherwise) on its ability to do so

Functional Competencies:

GOM_ Plan/Implement/Manage Medical Coding Quality Programs and Strategies + Develop and tailor quality improvement plans aligned with regulatory and payer requirements
+ Analyze client contracts, coding guidelines, and payer policies to incorporate into operational plans
+ Support internal teams and external partners in resolving coding-related issues and ensuring accurate implementation of coding protocols
+ Establish and monitor service level agreements (SLAs) for coding accuracy, turnaround time, and audit responsiveness
+ Identify and secure resources (e.g., certified coders, audit tools, training platforms) necessary for program success
+ Review and optimize coding workflows to ensure compliance, efficiency, and scalability
+ Provide expert guidance to cross-functional teams (e.g., coding, OpX, compliance) to ensure coding strategies are effectively implemented
+ Interpret regulatory and contractual coding requirements to support accurate documentation and reimbursement
GOM_Monitor/ Evaluate Medical Coding Quality Program Performance + Collect feedback from stakeholders to assess the effectiveness of coding quality initiatives
+ Monitor coding accuracy, audit outcomes, and compliance metrics against SLAs and industry benchmarks
+ Collaborate with internal teams (e.g., coding, OpX, compliance) to produce accurate performance reports
+ Utilize dashboards and scorecards to track coding quality trends and identify areas for improvement
+ Validate and analyze coding data to ensure accuracy and completeness
+ Review consolidated performance reports to identify gaps, recommend corrective actions, and explore opportunities for program expansion
+ Integrate coding performance insights into strategic planning and operational forecasting
+ Delegate post-implementation tasks to ensure contractual and regulatory obligations are met
+ Analyze coding performance using key indicators (e.g., RADV, OIG audits
GOM_Build/Maintain/Manage Relationships with Coding Operations and Compliance Stakeholders + Develop a deep understanding of stakeholder roles across coding, compliance, clinical, and revenue cycle teams
+ Provide regular performance updates through scorecards and audit summaries
+ Lead recurring meetings (e.g., quality reviews, audit debriefs) to discuss coding accuracy, compliance issues, and improvement plans
+ Create and manage corrective action plans to address coding discrepancies and audit findings
+ Conduct in-depth reviews with stakeholders to identify continuous improvement opportunities
+ Ensure stakeholders are informed of updated coding guidelines, payer policies, and regulatory changes
+ Collaborate with internal and external partners to develop coding strategies that support quality, compliance, and financial goals.
GOM_Support/Develop/Ensure Compliance with Coding Policies, Procedures, and Regulations + Maintain up-to-date knowledge of coding standards (e.g., ICD-10, RA coding standards), payer guidelines, and regulatory requirements (e.g., CMS, OIG)
+ Educate staff on coding policies, documentation standards, and regulatory updates
+ Interpret and communicate contractual and regulatory coding requirements to ensure compliance
+ Contribute to the development and revision of coding policies and procedures
+ Ensure staff access and utilize current coding resources and regulatory updates
+ Track training completion and compliance with coding education requirements
+ Monitor and report coding compliance metrics (e.g., audit results, error trends) to internal and external stakeholders
GOM_Review/Manage/Drive Operations Efficiency, Quality, and Financial Performance + Leverage stakeholder feedback to drive continuous improvement in coding quality and operational efficiency
+ Ensure adherence to coding-related business and contractual obligations
+ Conduct end-to-end testing of coding workflows and systems to validate compliance and accuracy
+ Review and test business continuity plans related to coding operations
+ Use analytics tools to identify opportunities for coding process optimization
+ Demonstrate understanding of budgeting and forecasting as it relates to coding resource allocation and audit planning
+ Analyze budget variances and recommend adjustments to support coding quality initiatives
+ Collaborate with finance and compliance teams to forecast resource needs and support strategic planning
+ Assign coding quality projects based on team capacity, expertise, and performance metrics

Values Based Competencies

Integrity Value: Model and Ensure Ethical Behavior + Comply with Applicable Laws, Regulations and Policies
+ Demonstrate Integrity
+ Require Integrity and Ethical Behavior from Others
Compassion Value: Deliver Value to Customers + Maximize Customer Growth and Retention
+ Optimize the Customer Experience
Relationships Value: Lead and Develop People + Bring in the Right Talent
+ Develop People
+ Drive Employee Engagement
+ Foster Teamwork and Collaboration
+ Learn and Develop Self
+ Leverage Diversity and Inclusion
Relationships Value: Communicate Effectively + Communicate with Impact
+ Influence and Negotiate
+ Listen Actively
+ Present Effectively
Innovation Value: Lead Change and Innovation + Demonstrate Emotional Resilience
+ Implement Innovative Solutions
+ Manage Change
+ Performance Value: Drive Sound, Disciplined Decisions
+ Apply Financial Knowledge
+ Make Decisions to Drive Action
Performance Value: Drive High-Quality Execution + Communicate Clear Direction
+ Drive Operational Excellence
+ Manage Execution

Required Qualifications:

13+ years of leadership experience, including managing large, cross-functional teams in healthcare operations 12+ years of specialized expertise in medical coding, with a solid focus on Risk Adjustment coding standards, methodologies, and compliance Proven experience in overseeing clinical case reviews and RA coding audits, ensuring accuracy, completeness, and adherence to regulatory guidelines Hands-on experience managing business operations related to: + Risk Adjustment Coding
+ Clinical Investigations
+ RX Revenue Cycle Management (RCM)
+ Provider Coding
Demonstrated ability to manage P&L responsibilities for business units, driving performance and cost optimization Successfully led and scaled teams of 350+ FTEs, fostering a culture of quality, accountability, and continuous improvement Solid Project Management capabilities, including planning, execution, and delivery of strategic initiatives in coding quality and compliance
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone - of every race, gender, sexuality, age, location and income - deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.