Director, Compliance - FFS Coding - Remote
About the Role
Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The Director, Compliance - FFS Coding is a strategic leadership role within Optum Coding Compliance, providing fee-for-service (FFS) coding expertise across inpatient, outpatient facility, and professional services coding. This role provides compliance guidance to Optum FFS coding teams, including Optum Insight clients, and leads Optum-wide FFS coding compliance processes. You'll enjoy the flexibility to work remotely from anywhere within the U.S., though hires in the Minneapolis or Washington, D.C. area will be required to work in the office a minimum of four days per week.
Responsibilities
- Drive compliance strategy for the FFS-related components of the Optum Coding Compliance program; collaborate with enterprise compliance and business partners to implement that strategy.
- Design and execute a risk-based FFS audit plan to supplement business quality assurance processes. Drive remediation of issues identified through compliance-led audits, including oversight and tracking of remediation derived from quality assurance processes.
- Manage coding compliance professionals supporting the Optum Coding Compliance program; provide FFS coding expertise to support other members of the Optum business compliance and legal teams.
- Engage with stakeholders at all levels of the organization and evaluate critical processes related to FFS coding compliance.
- Administer program oversight and collaborate with business leaders and teams to support ongoing reviews, implementation of requirements, and corrective action, as necessary.
- Establish and maintain routine oversight standards and make recommendations for operational improvements.
- Contribute, as needed, to Optum-level FFS coding compliance training and education, policies, and communications to promote compliance with applicable laws and coding standards.
- Collaborate with business, operations, and other functional compliance areas to review, analyze, and develop or oversee implementation projects to ensure compliance with new FFS coding standards, requirements, or audit execution.
- Report FFS coding compliance activities to management and ensure effective management of oversight activities.
Requirements
- CCS, CPC, RHIT or similar coding certification.
- 10+ years of experience with increasing responsibility for FFS coding or related compliance functions with proven history of successful results in managing functional compliance.
- Proven experience with auditing, monitoring, and provider education.
- Experience with compliance software, EMR systems, and coding platforms.
- Experience working with senior executives.
- Deep understanding of outpatient, inpatient, and specialty coding, CMS regulations, NCD and LCD guidelines, DRG methodologies.
- Solid communication skills and business acumen.
- Self-starter with proven track record of driving results in heavily matrixed environment.
- Collaborative, innovative, accountable, and agile team leader.
- Excellent strategic decision-making, analytic, influence, and communication (written and verbal) skills.
- Knowledge of risk management methodologies and tools, including ability to identify and manage resources.
- Demonstrated ability to lead and influence in a large, matrixed organization.
- Proven ability to drive cross-functional teams to deliver operational compliance.
- Objective, collaborative approach. Ability to adapt in a dynamic and high-growth environment.
- Familiarity with health plan benefits operations.
Benefits
- Comprehensive benefits package.
- Incentive and recognition programs.
- Equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements).
Pay
The salary for this role will range from $134,600 - $230,800 annually based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, and certifications.