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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 Leader for Knowledge team will lead all the SME deployed on the floor across all the 4 location in the provider coding area. This position need to have a core clinical / medical back ground so that the right interventions on the floor can be provided. This role becomes imperative given the multiple high intensity knowledge road map of FTE implementation in the next 1 year starting with:

• Outpatient Academy

• Inpatients Academy

• HIM / ROI Business

• Zero Defect coding initiative

• Rest of new client implementation

Primary Responsibilities:

• Ensuring Accuracy and Compliance

• Accuracy in Coding: Ensure that all codes are accurate, reducing the risk of claim denials and rejections

• Regulatory Compliance: Healthcare regulations and coding standards (such as ICD-10, CPT, and HCPCS) are constantly evolving. A QA Executive stays updated with these changes and ensures the team adheres to the latest guidelines, minimizing legal and financial risks

• Improving Financial Performance

• Revenue Optimization: Accurate coding leads to correct billing, which maximizes revenue

• Reduction in Denials: Proactively identifying and addressing coding issues, reducing denied claims which can be costly and time-consuming to appeal

• Enhancing Operational Efficiency

• Floor level Training and Development: Provide ongoing training to the coding team, ensuring they are proficient in the latest coding practices and technologies

• Continuous Process Improvement: Analyzing coding workflows and identifying bottlenecks or inefficiencies and recommend and implement process improvements

• Maintaining High Standards of Quality

• Quality Audits: Regular audits conducted helps maintain high standards of coding quality. These audits identify areas for improvement and ensure that corrective actions are taken promptly

• Benchmarking: Benchmarks the team's performance against industry standards and best practices, striving for continuous improvement and excellence

• Risk Mitigation

• Fraud Prevention: Identify and prevent fraudulent coding practices, protecting the organization from potential legal issues and financial penalties

• Data Security: Ensuring that coding practices comply with data security regulations (such as HIPAA) is crucial. A QA Executive oversees these practices to safeguard patient information

• 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

Required Qualifications:

• Graduate or Postgraduate in: Life Sciences, Allied Medicine (BHMS, BAMS, BPT, Dental Grads, Pharmacist, Nursing) or others

• Certified coder - AAPC / AHIMA - CCS/CPC/CPC-H/CCS-P

• 8+ years of coding experience with about 3+ years of experience as a Team Lead

• Knowledge of organizational structure, workflow, and operating procedures

• Thorough knowledge of medical terminology, human anatomy/ physiology, pathophysiology

• Proficient in healthcare reimbursement methodologies

• Proven ability to manage and enable teams to reach their goals

• Proven good analytical and communication skills

• Proven solid interpersonal and communication skills

• Proven solid acumen towards employee engagements & driving customer satisfaction

• Proven ability to work closely with SME, Auditor and Trainer and identify training needs for outliers

• Proven ability to effectively provide 1 on 1 coaching

• Proven ability to monitor absences and overall day-to-day operations

• Proven ability to identify areas of weakness and provide educational teaching to improve those areas of weakness

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.