Associate Director - Medical Coding

Hyderabad, Telangana
Permanent
Full-time

1 month ago

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
Compassion Value: Deliver Value to Customers

Maximize Customer Growth and Retention
Optimize the Customer Experience
Relationships Value: Lead and Develop People

Bring in the Right Talent
Develop People
Drive Employee Engagement
Foster Teamwork and Collaboration
Learn and Develop Self
Leverage Diversity and Inclusion
Relationships Value: Communicate Effectively

Communicate with Impact
Influence and Negotiate
Listen Actively
Present Effectively
Innovation Value: Lead Change and Innovation

Demonstrate Emotional Resilience
Implement Innovative Solutions
Manage Change
Performance Value: Drive Sound, Disciplined Decisions

Apply Financial Knowledge
Make Decisions to Drive Action
Performance Value: Drive High-Quality Execution

Communicate Clear Direction
Drive Operational Excellence
Manage Execution

EligibilityTo apply to an internal job, employees must meet the following criteria:

12+ months of continuous service in their current grade and position
Performance rating in the last common review cycle of “Meets Expectations” or higher
Not on any active CAP (Corrective Action Plan) or active disciplinary action
SG 28 and 29 are eligible to apply
Time in Role Guidelines

Should have been in your current position for a minimum of 12 months, if you have not met the recommended minimum time in role, discuss your career interest with your manager and gain alignment prior to applying. And share the alignment email with respective recruiter while applying

Required Qualifications:

Undergraduate degree from an accredited college/university
Medical coding Certified with AAPC or AHIMA
14+ years of people management experience
13+ years of solid Medical coding background.
Experience handling Business Pertaining to Risk adjustment coding or Provider coding
Experience in Handling and Managing the P&L for any of the business units
Project Management experience
Handled 350+FTE as team size

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

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