Revenue Assurance SME – Remote

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.

The Revenue Assurance SME is primarily responsible for the development, maintenance, communication, and audit functions of a standard, regulatory-focused Corporate Charge Description Master (CDM). The Optum Corporate Standard is built and maintained with a strict compliance-centric focus on the contained information but is designed to be versatile and creative in its use. The position works in a collaborative team environment to provide value to customers both internal and external to Optum 360.

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.

• Audit the Corporate Standard CDM/client CDMs to ensure compliance with regulatory agencies and applicable policies

• Thinks outside the box to discover and present new ways to utilize and analyze large and complex datasets

• Uses data visualization techniques to drive collaborative, data-driven decision making with Optum and Client leadership

• Makes decisions that require significant analysis and investigation with solutions requiring original thinking

• Maintains current knowledge in applicable rules and regulations and disseminates relevant information to clients and other areas of the Revenue Cycle

• Interacts with leadership, department managers and regional facility staff members regarding alignment and adherence to corporate standard, regulatory compliance, and reimbursement issues

• Responds to customer inquiries professionally and can analyze revenue cycle questions and issues to resolution

• Ability to prioritize workload and balance numerous projects simultaneously while delivering timely results

• Creates and effectively delivers regulatory guidance and educational materials to internal and external customers

• Take initiative to identify system and / or operational problems and participate in the development of solution for improvement to billing functions for client facilities

• Serves as a resource to EHR / implementation project team members

• Demonstrate flexibility and willingness to support the changing needs and priorities of the department and organization

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.

• Revenue Cycle related credential of any type (AAPC, AHIMA, HFMA, NAHRI etc.) or the ability to obtain within the first 12 months of employment

• 3+ years of experience in Medicare/CMS Regulatory Guidance

• 3+ years of work experience in a health care environment with focus in billing, coding, revenue cycle process, compliance, or CDM type work

• 3+ years of experience understanding and employing fundamental concepts, practices, and procedures relating to healthcare facilities and their operations

• 3+ years of experience with financial and regulatory risk involving facility and professional charging practices

• 3+ years of experience of business operations and in-house business systems

• Proven advanced understanding and capabilities in Microsoft Excel

• Proven ability to communicate analysis, including trends and opportunities to clients and the business both verbally and through writing/visualization

• Proven solid problem-solving skills with a structured, process-oriented approach

• Proven expertise in continuous process improvement and root cause analysis

• Proven ability to manage…