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Optum · 1 month ago

Compliance Analyst - National - Remote

United States

Full-time

Remote

Mid, Senior Level

$59K/yr - $105K/yr

5+ years exp

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The Compliance Analyst will be responsible for ensuring regulatory compliance through audits, monitoring changes to laws and regulations, and maintaining solid client relationships. This role requires expertise in coding practices and collaboration with various stakeholders to address compliance issues effectively.

EducationHealth CareMedicalPharmaceutical

Responsibilities

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 Optum360 Coding related business objectives within the client environment

Serve as the expert of applicable Federal, State, and local laws and regulations, Optum360'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

Conduct internal monitoring/auditing to identify process gaps and help the business address organizational risks

Collaborate with internal stakeholders across organization lines to help identify root causes of compliance issues, and support appropriate action to mitigate risk, as needed

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 (e.g., fraud, waste and abuse)

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)

Provide quality performance feedback by completing internal coding quality audits to the coding specialist staff, coding team leadership, and coding educators

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 Optum360 leadership

Qualification

AAPCAHIMA certificationInpatient coding experienceComputer assisted codingEMR coding workflowMicrosoft Excel proficiencyHonestyOrganizational skillsCollaboration skillsCommunication skillsIntegrity

Required

High School Diploma/GED

AAPC or AHIMA (CCS, CPC, RHIT or RHIA) certification

5+ years of experience with Inpatient coding and/or in an Inpatient coding reviewer role, prefer recent experience

1+ years of experience working collaboratively with CDI and quality leadership in partnership to improve reimbursement and coding accuracy

1+ years of experience with computer assisted coding technologies and EMR (Electronic Medical Record) coding workflow

Intermediate level of proficiency with Microsoft Excel, Word, PowerPoint, and SharePoint

Preferred

Outpatient coding experience in a coder or reviewer role

Operational knowledge of health care related to Federal and State regulations, as well as standards from regulatory agencies and accrediting organizations (e.g., CMS, TJC)

Proven excellent organizational skills required (ability to multi-task, produce rapid turnaround, and effectively manage multiple projects)

Demonstrated ability to work with a variety of individuals in executive, managerial and staff level positions. The incumbent frequently interacts with staff at the Corporate/National, Regional and Local organizations. May also interact with external parties, such as financial auditors, third party payer auditors, consultants, and various hospital associations

Demonstrated ability to possess a personal presence that is characterized by a sense of honesty, integrity, and caring with the ability to inspire and motivate others to promote the philosophy, mission, vision, goals, and values of Optum360 and our client organization(s)

All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

Benefits

Comprehensive benefits package

Incentive and recognition programs

Equity stock purchase

401k contribution

Company

Optum

Glassdoor3.6

Optum is a healthcare company that provides pharmacy services, health care operations, and population health management. It is a sub-organization of UnitedHealth Group.

Founded in 2011

Eden Prairie, Minnesota, USA

10001+ employees