SME - Home Health Coding

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:

• KPIs include but not limited to Productivity, quality, TAT, Attendance and Attrition
• Quick turnaround using logical understanding of data
• Manages overall personnel, performance, and discipline of the assigned project(s)
• Provide expertise and leadership in assigned functional area
• Manage relationship with internal stakeholders and functions
• Manage all client interaction and client communication. Should front end the relationship with the client
• Review and analysis of periodic reports and metrics
• Evaluation of operational practices and procedures
• Provide support to quality initiatives targeted towards process improvements
• Actively involved in the internal audit support, ensuring all compliance parameters are met
• Establish and maintain a working environment conducive to positive morale, individual style, quality, creativity, and teamwork
• Provide direction to staff; ensure resolution of problems; sets priorities
• Actively provides inputs and assistance to the senior management in the planning, implementation, and evaluation / modifications to existing operations, systems, and procedures, specifically relating to his/her assigned project(s)
• Managing attrition and building retention strategies
• Preparation of annual business plans including operating budgets
• Negotiating solutions, resolving conflicts and anticipating/handling critical situations
• Providing regular performance feedback and giving frequent formal and informal coaching session
• 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:

• 4+ years of experience
• Any medical coding certification (CPC,CCS etc); BCHH‑C
• Understanding of PDGM (Patient-Driven Groupings Model):
  • Primary diagnosis selection
  • Comorbidity adjustments
• Proven skill in identifying missing, conflicting, or insufficient documentation
• Proven ability to perform provider queries when needed
• Proven analytical thinking and problem‑solving
• Proven training and mentoring capability (for SME roles)
• Proven solid command over ICD‑10‑CM guidelines (Chapters 1-21)
• Proven ability to apply etiology/manifestation coding rules
• Proven expertise in coding diabetes, wounds, fractures, CVA late effects, COPD, CHF, etc.

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.