DescriptionIf you want to achieve more in your mission of health care, you have to be really smart about the business of health care. Challenge yourself, your peers and our industry by shaping what health care looks like and doing your life's best work.(sm)
Clinical Performance (CP) is charged with effectively implementing, monitoring, and executing on clinical documentation, quality, and affordability programs that promote patient health while improving the provider practice experience with a special focus on Medicare Risk Adjustment and HEDIS. Clinical Performance processes on a national level by providing support in all markets served by OptumCare Delivery.
This position will report into the Director of Risk Adjustment Submissions and will be overall responsible for process design, optimization and implementation of Care Delivery Organization (CDO) Risk Adjustment program data.
- Design, optimize, and implement alternate submission method (ASM) capabilities, including data intake, data management, error corrections, issue resolution, reconciliation, and submission file creation
- Consult with market CDO’s on process design and integration with National programs
- Responsible for establishing and owning processes and controls to ensure that data collected and submitted is complete and accurate
- Responsible for the day to day management of established processes and controls and working with business partners to ensure processes and controls are implemented in accordance with defined objectives
- Responsible for coordination and implementation of processes and controls across key stakeholders within Clinical Performance
- Consult and work directly with CDO’s and Business solution groups to ensure successful execution of operational objectives in accordance with established customer SLAs and compliance requirements
- Develop and maintain process flows, user guides, requirements, etc. to support the business
- Facilitate weekly touch points with leader to provide updates and identify risks and opportunities related to established processes and controls
- Creates dashboards and operational metrics/reporting to demonstrate successful delivery of performance objectives
- Collaborates with operational partners to drive productivity and efficiency
Critical Success Factors:
- Knowledge of CMS Risk Adjustment and ICD-10 coding requirements and regulations
- Understanding of CMS encounter data submission and processing guidelines
- Self-starter and proven ability to work independently to drive change
- Working in a matrix environment to drive efficiencies through influence and relationships
- Bachelor’s degree or equivalent experience required; Master’s degree preferred
- 3+ years of progressive leadership experience including leading operations, and/or business process improvement initiatives
- 2+ Years experience with SQL programming
- Technical competency with experience creating and applying data analytics to solve business problems
- Strong leadership skills with proven ability to foster and manage senior-level relationships in a highly matrixed environment
- Superior verbal and written communication skills
- Ability to influence with and without direct management/authority
- Superior customer/consultant relationship management and collaboration skills
- Employees are required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or a similar UnitedHealth Group-approved symptom screener prior to entering the work site each day, in order to keep our work sites safe. Employees must comply with any state and local masking orders. In addition, when in a UnitedHealth Group building, employees are expected to wear a mask in areas where physical distancing cannot be attained.
- Microsoft Office Suite (Excel, Word; PowerPoint; Visio)
- Risk Adjustment experience working with encounter data and submissions
- Working knowledge of quality, risk adjustment and medical management
- Knowledge of federal (e.g., CMS) and state laws and regulations relating to Medicare Advantage
- Ability to build strong relationships across a variety of stakeholders
Careers at OptumCare. We're on a mission to change the face of health care. As the largest health and wellness business in the US, we help 58 million people navigate the health care system, finance their health care needs and achieve their health and well-being goals. Fortunately, we have a team of the best and brightest minds on the planet to make it happen. Together we're creating the most innovative ideas and comprehensive strategies to help heal the health care system and create a brighter future for us all. Join us and learn why there is no better place to do your life's best work.(sm)
OptumCare is committed to creating an environment where physicians focus on what they do best: care for their patients. To do so, OptumCare provides administrative and business support services to both owned and affiliated medical practices which are part of OptumCare. Each medical practice part and their physician employees have complete authority with regards to all medical decision-making and patient care. OptumCare’s support services do not interfere with or control the practice of medicine by the medical practices or any of their physicians.
Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
Job Keywords: SQL. Analytics, Eden Prairie, Minnesota, MN