Overview
Optum Insight is improving the flow of health data and information to create a more connected system. We remove friction and drive alignment between care providers and payers, and ultimately consumers. Our deep expertise in the industry and innovative technology empower us to help organizations reduce costs while improving risk management, quality and revenue growth. Ready to help us deliver results that improve lives? Join us to start
Caring. Connecting. Growing together.
The Coding Strategy Lead serves as the primary Medical Coding Subject Matter Expert (SME) for Revenue Cycle Management (RCM) Center of Excellence. This role is responsible for developing and executing coding strategies, ensuring compliance with regulatory and coding changes, managing regulatory complaints, and maintaining a compliant charge master aligned with federal and state regulations. In addition, this position partners closely with Denial Prevention and Payer Solutions teams to address root causes of denials requiring coding expertise. As a key leader within the organization, you will influence change across clinical and non-clinical teams at multiple levels and functions within one or more business units.
Success in this role will be measured by:
Improved initial and final denial write-off rates
Reduced accounts receivable (A/R) aging
Decreased appeals
You will collaborate with operations to drive coding strategies for systemic billing issues impacting all MPP clients. Responsibilities include day-to-day operations management, oversight of escalated issues, development of resolution plans, risk mitigation, and creation of growth strategies through opportunity assessments. This role carries accountability for both financial and non-financial outcomes, requires regular client engagement, and ensures adherence to operational performance agreements and regulatory compliance. Additional responsibilities include developing presentations and materials, prioritizing work queues, and creating contingency plans for missed deliverables. The role also leads regulatory complaint resolution and represents RCM Operations in Joint Operating Committee (JOC) calls with payers to address systemic misalignments.
You'll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities
Execute strategic plans in partnership with enterprise leadership, including short- and long-term coding strategies
Lead implementation and strategy for regulatory complaint management within RCM Center of Excellence
Represent RCM Operations as SME during JOC calls with payer partners
Provide coding expertise during payer contract negotiations to address deficiencies
Drive informed business decisions leveraging both clinical and coding knowledge
Ensure achievement of key service level agreements (e.g., Initial Denial Rate, Final Denial Write-Off, Aging A/R, Appeal Overturns)
Identify and remove operational barriers; conduct deep-dive program reviews to uncover improvement opportunities
Promote continuous improvement in productivity and operational efficiency
Partner to review, create, and maintain coding workflows to ensure accuracy and efficiency
Provide guidance and expertise to internal and external partners for effective program implementation
Interpret contractual requirements and communicate strategies to resolve issues
Conduct regular stakeholder meetings to review updates, compliance audits, and operational challenges
Develop corrective action plans to address stakeholder concerns and operational issues
You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications
8+ years in Revenue Cycle Management
8+ years of coding experience with certifications in both Professional and Facility Coding
5+ years influencing C-Suite decisions
3+ years using operational metrics, analytics, and dashboards to drive performance
3+ years of leadership experience across operational teams and functions
Experience with line-item denials and policy
Intermediate proficiency in Microsoft Office Suite (Word, PowerPoint, Excel, Outlook)
Advanced Excel skills (filters, pivot tables, formulas)
Preferred Qualifications
Experience in Payer - Managed Health Care
Payment Integrity
Additional Qualifications
Ability to manage sensitive, escalated situations with internal and external customers
Solid self-motivation and disciplined follow-through
Highly collaborative with experience in growth strategy development and execution
Ability to build credibility and relationships at all organizational levels
Comfortable working in a matrixed, fast-paced environment with tight deadlines
All employees working remotely
will be required to adhere to UnitedHealth Group's Telecommuter Policy
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $112,700 to $193,200 annually based on full-time employment. We comply with all minimum wage laws as applicable.
Application Deadline:
This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone—of every race, gender, sexuality, age, location and income—deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.
UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
#J-18808-Ljbffr
Caring. Connecting. Growing together.
The Coding Strategy Lead serves as the primary Medical Coding Subject Matter Expert (SME) for Revenue Cycle Management (RCM) Center of Excellence. This role is responsible for developing and executing coding strategies, ensuring compliance with regulatory and coding changes, managing regulatory complaints, and maintaining a compliant charge master aligned with federal and state regulations. In addition, this position partners closely with Denial Prevention and Payer Solutions teams to address root causes of denials requiring coding expertise. As a key leader within the organization, you will influence change across clinical and non-clinical teams at multiple levels and functions within one or more business units.
Success in this role will be measured by:
Improved initial and final denial write-off rates
Reduced accounts receivable (A/R) aging
Decreased appeals
You will collaborate with operations to drive coding strategies for systemic billing issues impacting all MPP clients. Responsibilities include day-to-day operations management, oversight of escalated issues, development of resolution plans, risk mitigation, and creation of growth strategies through opportunity assessments. This role carries accountability for both financial and non-financial outcomes, requires regular client engagement, and ensures adherence to operational performance agreements and regulatory compliance. Additional responsibilities include developing presentations and materials, prioritizing work queues, and creating contingency plans for missed deliverables. The role also leads regulatory complaint resolution and represents RCM Operations in Joint Operating Committee (JOC) calls with payers to address systemic misalignments.
You'll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities
Execute strategic plans in partnership with enterprise leadership, including short- and long-term coding strategies
Lead implementation and strategy for regulatory complaint management within RCM Center of Excellence
Represent RCM Operations as SME during JOC calls with payer partners
Provide coding expertise during payer contract negotiations to address deficiencies
Drive informed business decisions leveraging both clinical and coding knowledge
Ensure achievement of key service level agreements (e.g., Initial Denial Rate, Final Denial Write-Off, Aging A/R, Appeal Overturns)
Identify and remove operational barriers; conduct deep-dive program reviews to uncover improvement opportunities
Promote continuous improvement in productivity and operational efficiency
Partner to review, create, and maintain coding workflows to ensure accuracy and efficiency
Provide guidance and expertise to internal and external partners for effective program implementation
Interpret contractual requirements and communicate strategies to resolve issues
Conduct regular stakeholder meetings to review updates, compliance audits, and operational challenges
Develop corrective action plans to address stakeholder concerns and operational issues
You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications
8+ years in Revenue Cycle Management
8+ years of coding experience with certifications in both Professional and Facility Coding
5+ years influencing C-Suite decisions
3+ years using operational metrics, analytics, and dashboards to drive performance
3+ years of leadership experience across operational teams and functions
Experience with line-item denials and policy
Intermediate proficiency in Microsoft Office Suite (Word, PowerPoint, Excel, Outlook)
Advanced Excel skills (filters, pivot tables, formulas)
Preferred Qualifications
Experience in Payer - Managed Health Care
Payment Integrity
Additional Qualifications
Ability to manage sensitive, escalated situations with internal and external customers
Solid self-motivation and disciplined follow-through
Highly collaborative with experience in growth strategy development and execution
Ability to build credibility and relationships at all organizational levels
Comfortable working in a matrixed, fast-paced environment with tight deadlines
All employees working remotely
will be required to adhere to UnitedHealth Group's Telecommuter Policy
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $112,700 to $193,200 annually based on full-time employment. We comply with all minimum wage laws as applicable.
Application Deadline:
This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone—of every race, gender, sexuality, age, location and income—deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.
UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
#J-18808-Ljbffr