Compliance Analyst - National - Remote

Regulatory Compliance Auditor

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.

Responsible for regulatory compliance audits, including but not limited to regulatory agencies, quality metrics, and coding compliance. The Auditor will monitor changes to laws and regulations to ensure compliance with state and federal laws, regulations and mandates. Establish and implement standard policies, procedures, and best practice across Optum Middle Revenue Cycle. This role is responsible for client facing meetings with the Quality Teams, CDI, and others directly related to accounts associated with prebill reviews, such as HAC / PSIs. This position must maintain solid client relationships and represent Optum360 in all aspects of its values. If you call yourself a data guru, then you'll be perfect for this role. As you respond to inquiries, requests and actions, you'll need to be able to communicate research and data findings in a meaningful way. You will also be responsible for monitoring internal and external regulatory audits. You'll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges. For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week.

Primary Responsibilities

• Maintain and demonstrate expert knowledge of coding, coding operations, coding review of all coding staff (domestic and global) and best demonstrated coding practices; drives the integration of Optum360 Coding related business objectives within the client environment
• Serve as the expert of applicable federal, state, and local laws and regulations, Optum360's organizational integrity program, standards of conduct, as well as other policies and procedures to ensure adherence in a manner that reflects honest, ethical, and professional behavior.
• Promote a service-oriented culture within the organization and assure satisfaction with the quality and amount of support provided for departmental functions, initiatives, and projects
• Communicate the potential impact of compliance issues and risks on our business, operations, and consumers to applicable stakeholders, including both segment-specific and enterprise-wide implications
• Collaborate with applicable regulators to prevent or address potential compliance issues within our organization
• Conduct internal monitoring / auditing to identify process gaps and help the business address organizational risks
• Collaborate with internal stakeholders across organization lines to help identify root causes of compliance issues, and support appropriate action to mitigate risk, as needed
• Analyze results of audits and monitoring processes to identify potential risks, and communicate as needed
• Identify and analyze applicable patterns / trends to identify potential compliance issues, and communicate as needed (e.g., fraud, waste and abuse)
• Develop and / or deliver training on compliance issues and risks to applicable audiences
• Consult with internal and external stakeholders to advocate and drive effectiveness of our compliance programs
• Partner with applicable learning organizations as needed to develop / implement compliance training offerings
• Consult with applicable business partners to identify effective approaches to support / enforce compliance within their business
• Provide input on business training programs as needed to promote inclusion of appropriate compliance content
• Assess and respond to the need for required compliance training among external stakeholders, as appropriate
• Provide quality performance feedback by completing internal coding quality audits to the coding specialist staff, coding team leadership, and coding educators
• Act as liaison for all external quality stakeholders which include but not limited to compliance, core measures, patient safety, and premier data integrity
• Support coding team leadership with quality data reporting and work with coding educators on opportunities for educational topics for coders
• Other duties as needed and assigned by Optum360 leadership

Required Qualifications

Preferred Qualifications

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. The salary for this role will range from $58,800 to $105,000 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. 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.