Clinical Coding Director - Telecommuter

If you want to achieve more in your mission of health care, you have to be really smart about the business of health care. Challenge yourself, your peers and our industry by shaping what health care looks like and doing your life's best work.(sm)

This role resides within Optum Shared Services and provides commercial service offerings sold via OptumInsight's Payer Services. These services focus on working with clients to identify providers who may need assistance with coding documentation and prioritization of seeing patients with the largest gaps in care. Initially, they will work with 2 large commercial clients; 2015 growth target 5-7 accounts.

The Director, Clinical Coding will be responsible for coordinating team activities around educating providers and coding educators to more accurately document member's conditions for accurate submission to CMS and will comply with Coding and Corporate Compliance standards, as well as ethical standards and official coding guidelines. The individual in this role will be client facing and expected to provide strong leadership and direction in implementing the Clinical Risk Adjustment (CRA) program. 

Primary Responsibilities:

• Manage a team of Clinical Coding Analysts/Consultants and oversee their Prospective Activities programs, provide mentoring and leadership direction to achieve team goals and objectives (total staff up to 50+)


• Provide leadership and direction, effectively build and deepen relationships with internal and external business partners, vendors, and internal teams.


• Provide program reporting to senior leadership and client management regarding progress with provider activities


• Conduct chart reviews of members via regular travel to individual practices/locations and performing onsite audits and physician chart audits (including research and presentation). Assess/interpret if coding assigned by the client is accurate based upon review of the medical documentation and application of the coding guidelines


• Oversee implementation of education, provide training to providers and staff as needed regarding coding compliance, documentation guidelines, usage of CCA long and short form, HCC education and Medicare/Medicaid regulations by proactively providing solutions to meet the needs of the provider


• Assist other team members in consistently applying coding practices, identifying missed coding opportunities and act as a resource to less experienced staff


• Responsible for maintaining current knowledge of coding guidelines and relevant federal regulations through the use of current ICD-9 CM book and other resources


• Assist with research, analysis, and response to inquiries regarding compliance coding issues and inaccuracies


• Provide feedback and present solutions regarding trends or patterns noticed in provider coding 

Required Qualifications:

• 4 year degree


• 4+ years of direct management experience


• 5+ years healthcare experience required; preferably in care management/wellness


• Thorough understanding of medical terminology, disease process and anatomy and physiology


• Understanding of ICD-9-CM coding classification and guidelines


• 3+ years successful implementation of multiple large, complex programs or projects via management of initiatives with wide organizational impact


• 2 or more years' experience presenting data (tracking, reporting, results, etc.) and complex ideas clearly and concisely to both internal and external audiences


• Demonstrated ability to build and maintain relationships that improve performance, establish trust and maintain credibility both internally and externally


• Ability to travel up to 75% to client locations


• Valid Driver's license


• CPC, CCS or RHIT certification or ability to complete within 6 months

Preferred Qualifications: 

• Completion of coding certification course, AAPC/AHIMA


• Knowledge of ICD-10 coding a plus  

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

Diversity creates a healthier atmosphere: 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: ICD-9-CM Coding, CPC, CCS, RHIT certification, AAPC/AHIMA, ICD-10 coding, Direct management, healthcare experience, clinical coding, telecommuter