The Risk Adjustment Validation Audit Manager - Remote

About the position 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.

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
• Assess, evaluate, and address variance in production and key goals for operations
• Participate in team meetings/discussions of quality trends reported by team members

Requirements

• 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

Nice-to-haves

• 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

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution

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