Risk Adjustment Validation Audit Manager - Remote at UnitedHealth Group Canada

St. Louis, Missouri, United States -

Full Time

Start Date

Immediate

Expiry Date

14 Feb, 26

Salary

160600.0

Posted On

16 Nov, 25

Experience

5 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Coding Certification, Risk Adjustment, Auditing, Process Improvement, Quality Reporting, Data Validation, Interpersonal Skills, Communication Skills, Organizational Skills, Attention to Detail, Microsoft Office, Leadership, Healthcare Experience, ICD-10-CM, Risk Adjustment Coding, KPI Tracking

Industry

Hospitals and Health Care

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. The Risk Adjustment Validation Audit Manager oversees the end - to - end business process activities by creating, controlling, and improving business processes. Will assist with process design and oversee project implementation, diagnosing process improvement opportunities and develop solutions using principles of process excellence and related tools. Will evaluate quality reporting, analysis, audits, developing plans and programs to support RADV process using a variety of applicable tools. You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities: Monitor quality activities to increase departmental accuracy and efficiency, including but 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 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. Required Qualifications: Coding Certification, i.e., CCS, CCS-P, CPC, CPC-H or CRN-C 5+ years of experience auditing Risk Adjustment records 1+ years of Risk Adjustment Data Validation Audit experience 1+ years working in an Operations/Production environment 1+ years of experience as a manager, responsible for performance management Experience tracking employee’s KPI’s (Key Performance Indicators) Intermediate (or higher) MS Office (Word, Excel & Outlook) Proficiency with Microsoft Word (ability to create, edit, save, and send documents) Microsoft PowerPoint (ability to create, edit, save, and send presentations) Proven excellent interpersonal, written, and verbal communication skills Proven excellent organizational ability to manage multiple projects and perform in a deadline driven environment Proven ability to maintain professionalism and a positive service attitude at all times Proven intense focus, attention to detail, and due diligence are paramount for this role No previous connection to the audit being performed Must be 18 years of age OR older Preferred Qualifications: Certified Risk Adjustment Coder Solid team player with 2+ years of leadership experience RHIA, RHIT, or Healthcare experience Inpatient and Outpatient Coding experience Experience utilizing claims data to target areas within the medical record to abstract ICD-10-CM codes that risk adjust within the v24 and V28 CMS Hierarchical Condition Categories (HCCs) Technical expertise in ICD-10-CM Knowledge of Risk Adjustment Data Validation (RADV) Coding Guidelines Proven ability to assimilate and adapt quickly and accurately Availability Requirements Onshore: Ability to work full-time, Monday - Friday. Employees are required to work our normal business hours of 8:00am – 5:00pm CST. It may be necessary, given the business need, to work weekends. Offshore: Ability to work full-time, Monday - Friday. Employees are required to work our normal business hours of 8:00am – 5:00pm IST. It may be necessary, given the business need, to work weekends. Telecommuting Requirements: Ability to keep all company sensitive documents secure (if applicable) Required to have a dedicated work area established that is separated from other living areas and provides information privacy Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet servic *All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you’ll find a far-reaching choice of benefits and incentives. The salary for this role will range from $89,900 to $160,600 annually based on full-time employment. We comply with all minimum wage laws as applicable. Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. 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. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

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Responsibilities

The Risk Adjustment Validation Audit Manager oversees the end-to-end business process activities, focusing on creating, controlling, and improving business processes. They will evaluate quality reporting, analysis, and audits while developing plans to support the RADV process.