Associate Director – Medical Coding

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.

Primary Responsibilities:

• Owns an end to end process
• Develops functional, market level, and/or site strategy, plans, production and/or organizational priorities
• Identifies and resolves technical, operational and organizational problems outside own team
• Product, service or process decisions are most likely to impact entire functions and/or customer accounts (internal or external)
• Comply with the terms and conditions of the employment contract, company policies and procedures, and any and all directives (such as, but not limited to, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regards to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment). The Company may adopt, vary or rescind these policies and directives in its absolute discretion and without any limitation (implied or otherwise) on its ability to do so

Functional Competencies

• GOM_Plan/Implement/Manage Operations Programs and Strategies
• Utilize standard project plan templates to create and/or tailor project plans to specific customers’ needs
• Analyze RFP/contract language and incorporate requirements into project plans
• Assist internal and/or external business partners with completion of tasks and resolution of issues and problems with program implementation
• Establish and/or implement internal and/or external service level agreements in order to ensure ability to monitor and measure program performance (e.g., turnaround time; quality; effectiveness)
• Identify and/or secure resources (e.g., funding; staffing; system security; real estate and/or telecommuting requirements; hardware/software) required to implement programs
• Review, create, and/or maintain workflows to ensure they are up-to-date and operationally efficient
• Provide guidance, expertise, and/or assistance to internal and/or external partners (e.g., claims; call center; benefits; clinical) to ensure programs and strategies are implemented and maintained effectively
• Communicate with and help internal and/or external partners interpret contractual requirements in order to ensure effective problem solution and strategy implementation
  Provide input to internal and/or external stakeholders (e.g., sales; shared business partners; pre-service vendors; facilities) in order to drive effective business plan and sales strategy development
• GOM_Monitor/Evaluate Operations Program and Strategy Performance
• Seek feedback from customers to determine success of overall project management and implementation
• Monitor project performance against internal and/or external service level agreements
• Work with internal and/or external partners (e.g., claims; call center) to ensure accurate reports are produced to validate program performance review
• Ensure performance is tracked accurately utilizing internal tools and processes (e.g., dashboards; scorecards; reports)
• Request and/or receive relevant performance data from internal partners and review for accuracy
• Manipulate provided data into applicable tools and reports in order to facilitate performance review and analysis
• Review consolidated operational performance reports in order to determine overall effectiveness, make necessary changes, and identify opportunities for new programs or program consolidation or expansion
• Incorporate operations program performance information into strategic and business planning
• Delegate post-implementation tasks to appropriate stakeholders to fulfill RFP/contractual agreements
• Analyze operational performance on relevant criteria (e.g., targeted financial metrics; quality indicators; performance guarantees and/or incentives)
• GOM_Build/Maintain/Manage Relationships with Operations Stakeholders
• Build and demonstrate an understanding of relevant business areas’ leadership, structure, responsibilities, and work flow
• Provide standard performance reports (e.g., scorecards) to update relevant internal and/or external stakeholders on the status of work projects
• Conduct regular meetings (e.g., JOCs; QBRs) with relevant internal and/or external stakeholders to review and discuss updates and outstanding issues (e.g., project implementation readiness; compliance and/or quality audit results; out-of-compliance issues; staffing issues)
• Develop corrective action plans to address and/or resolve relevant internal and/or external stakeholders’ concerns or issues regarding operational issues
• Conduct deep dive program reviews with relevant internal and/or external stakeholders to identify opportunities for continuous improvement
• Ensure relevant internal and/or external stakeholders (e.g., vendors; providers; leased network) are provided with correct and/or updated processes, programs, and/or policies (e.g., fee schedules)
• Partner with relevant internal and/or external stakeholders to develop and/or review potential operational strategies, programs, and plans (e.g., affordability initiatives; quality programs; projected resource needs)
• GOM_Support/Develop/Ensure Compliance with Operations Policies, Procedures, and Regulation
• Demonstrate understanding of and adhere to relevant policies, procedures, and regulations
• Stay abreast of changes and/or updates in relevant policies, procedures, and regulations
• Train and educate internal stakeholders on relevant policies and procedures
• Communicate and coordinate with and/or help internal and/or external partners interpret contractual requirements in order to ensure compliance with contractual and regulatory stipulations
• Provide input into, develop, and/or modify policies and procedures
• Ensure staff utilize relevant websites required in order to obtain up-to-date policies, guidelines, procedures, and regulations
• Track attendance on training for required policies, procedures, and regulations
• Monitor and/or report on-going compliance and related outcomes (e.g., claim denials; complaints; clinical metrics) to relevant internal and/or external stakeholders (e.g., regulatory agencies; customers; vendors)
• GOM_Review/Manage/Drive Operations Efficiency, Quality, and Financial Performance
• Utilize stakeholder input to help shape and implement continuous improvement in operational quality and financial performance (e.g., encourage participation in Six Sigma projects)
• Ensure internal partners and/or external vendors adhere to business and contractual agreements
• Conduct end-to-end testing of applicable processes, tools, procedures, and systems platforms to validate adherence to RFP/contract requirements
• Ensure that business continuity/emergency response plans are reviewed and tested regularly, up-to-date, and can be readily executed
• Utilize relevant systems and tools to identify and/or test opportunities for efficiency improvements (e.g., parallel variable testing)
• Demonstrate understanding of budgeting and forecasting tools, terminology, and processes
• Analyze budget performance and variances throughout the fiscal year, and recommend and/or make necessary adjustments and corrections
• Work with relevant internal partners (e.g., Finance; Underwriting) to identify resource requirements and/or create budgets and forecasts
• Review and assign projects/initiatives based on resource capacity, capability, and expertise

Values Based Competencies

• Integrity Value: Model and Ensure Ethical Behavior
• Comply with Applicable Laws, Regulations and Policies
• Demonstrate Integrity
• Require Integrity and Ethical Behavior from Others
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