Hospital Coding Subject Matter Expert

This position is National Remote. You'll enjoy the flexibility to telecommute

• from anywhere within the U.S. as you take on some tough challenges.

Explore opportunities with Optum , in strategic partnership with Pro Health Care. Pro Health Care is proud to be a leader in health care services, serving Waukesha County and the surrounding areas for more than a century. Explore opportunities across the full spectrum of care as you help us improve the well‑being of the community with your skills, compassion and innovation.

Be part of a collaborative environment that strives for excellence, nurtures respect and ensures high‑quality care delivery to our patients. Join us in making an impact as an Optum Team Member supporting Pro Health Care and discover the meaning behind Caring. Connecting. Growing together.

Responsible for providing oversight to Optum coding services, directly overseeing facility‑based and / or HIM (Health Information Management) Center operations leadership of Optum Coding Departments within the assigned Region. The SME will lead key initiatives within the organization related to Quality metrics, workflow improvement, and audits, etc. to meet or exceed metrics, drive efficient coding services, and deliver performance excellence through standardization of processes and focus primarily on ensuring best practices are followed within their respective facilities.

The Coding SME is a critical member of the Optum HIM / Coding Operations team. This role is responsible for client facing meetings with the Quality Teams, CDI, and others directly related to accounts associated with prebill reviews, such as, HAC / PSIs. The Coding SME drives continuous quality improvements and tracks, monitors, and trends performance to improve business objectives and to disrupt the status quo to exceed Service Level Agreement commitments.

This position must maintain strong client relationships and represent Optum in all aspects of its values.

This position is full‑time (40 hours / week) Monday – Friday. Employees are required to have flexibility to work any of our 8‑hour shift schedules during our normal business hours of 6am – 6pm. It may be necessary, given the business need, to work occasional overtime.

We offer weeks of on‑the‑job training and the hours during training will be during normal business hours.

• Maintains and demonstrates expert knowledge of coding, coding operations, coding review of all coding staff (domestic and global) and best demonstrated coding practices; drives the integration of Optum Coding related business objectives within the client environment.
• Identifies & builds consensus for facilitation of system and process standardization, utilization of best practices, work integration, change management, issue resolution, metric development and measurement, and communication related to the key components of coding operations.
• Works collaboratively with HIM, CDI, Client, and Coding Operations to monitor day to day coding operations, complete prebill coding reviews, and prebill quality reviews.
• Assists Coding Leadership with oversight of processes and initiatives designed to continuously improve coding quality and / or efficiency.
• Maintains expert knowledge of coding to ensure high level of accuracy and proficiency standards of performance are achieved to meet or exceed targets.
• Effectively leads and participates in coding quality assurance / compliance activities that include action plans relevant to audit results including remediation, education, and when appropriate assisting to create and monitor corrective action plans.
• Serves as the liaison between the coding operations collaboratively bring each unit together including establishing, building, and maintaining cohesive relationships with the client.
• Effectively utilizes tools and data provided to capture and continually improve union, client, and employee engagement. Leads initiatives towards meeting and exceeding employee satisfaction.
• Leads by example; promotes teamwork by fostering a positive, transparent, and focused working environment which achieves maximum results.
• Participates actively in leadership forums at the…