Remote Coding Quality & Compliance Auditor

Optum Insight is improving the flow of health data and information to create a more connected system. We remove friction and drive alignment between care providers and payers, and ultimately consumers. Our deep expertise in the industry and innovative technology empower us to help organizations reduce costs while improving risk management, quality and revenue growth. Ready to help us deliver results that improve lives?

Join us to startCaring. Connecting. Growing together.

Coding Quality Auditor is responsible for regulatory compliance audits, including but not limited to regulatory agencies, Quality metrics, and coding compliance. The Auditor will monitor changes to laws and regulations to ensure compliance with State and Federal laws, regulations and mandates. Establish and implement standard policies, procedures, and best practice across Optum Middle Revenue Cycle. 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.

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

You'll enjoy the flexibility to telecommute
* from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Conduct internal monitoring/auditing of inpatient coding charts to identify process gaps and help the business address organizational risks
• Analyze results of audits and monitoring processes to identify potential risks (e.g., risk assessments), and communicate as needed
• Identify and analyze applicable patterns/trends (e.g., using data analysis, news reports, reported concerns) to identify potential compliance issues, and communicate as needed
• Provide quality performance feedback by completing internal coding quality audits to the coding specialist staff, coding team leadership, and coding educators
• Maintain and demonstrate 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
  360 Coding related business objectives within the client environment
• Serve as the expert of applicable Federal, State, and local laws and regulations, Optum
  360's organizational integrity program, standards of conduct, as well as other policies and procedures to ensure adherence in a manner that reflects honest, ethical, and professional behavior. Promotes a service-oriented culture within the organization and assures satisfaction with the quality and amount of support provided for departmental functions, initiatives, and projects
• Communicate the potential impact of compliance issues and risks on our business, operations, and consumers to applicable stakeholders, including both segment-specific and enterprise-wide implications
• Collaborate with applicable regulators (e.g., CMS) to prevent or address potential compliance issues within our organization
• Collaborate with internal stakeholders across organization lines to help identify root causes of compliance issues, and support appropriate action to mitigate risk, as needed
• Develop and/or deliver training on compliance issues and risks to applicable audiences
• Consult with internal and external stakeholders to advocate and drive effectiveness of our compliance programs (e.g., government regulators, legal staff, vendors)
• Partner with applicable learning organizations as needed to develop/implement compliance training offerings (e.g., Learning & Development)
• Consult with applicable business partners to identify effective approaches to support/enforce compliance within their business
• Provide input on business training programs as needed to promote inclusion of appropriate compliance content (e.g., specialized compliance training)
• Assess and respond to the need for required compliance training among external stakeholders, as appropriate (e.g., vendors, delegated entities)
• Act as liaison for all external quality stakeholders which include but not limited to compliance, core measures, patient safety, and premier data integrity
• Support coding team leadership with quality data reporting and work with coding educators on opportunities for educational topics for coders
• Other duties as needed and assigned by Optum
  360 leadership

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear directions on what it takes to succeed in your role as well as provide development for other roles…