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Director Clinical Coding & Education

UnitedHealth Group

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Job Details

758664 Director Clinical Coding Education

Director Clinical Coding & Education (758664)

Position Description

For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us and help people live healthier lives while doing your life's best work.(sm)

The Director Clinical Coding & Education will work to correlate and align coding accuracy to the correct HCC & HEDIS / STARS assignment.  They will oversee and maintain responsibility for managing a team of medical chart reviewers- both coders and clinicians.  The primary focus of the coding team is to conduct audits that serve to improve and increase members annual funding to ultimately drive better patient care, as well as assist providers via education and training by improving RAF scores and STARS scores and accuracy.


The Director will ensure compliance with Coding and Corporate Compliance standards, abiding by ethical standards and official coding guidelines. They will perform the crucial task of assuring accuracy of codes from the listing of International Classification of Diseases, Tenth Revision; (ICD-10-CM), Medicare HEDIS gap analysis and consulting around gap closure to improve Stars ratings.


The Director Clinical Coding & Education will manage 10-15 certified coders and / or clinicians taking coding certifications, as well as partner with other field-based staff.  They will provide ICD10 and HCC coding training to providers and appropriate staff.   The Director will also develop and present coding presentations and training to large and small groups of clinicians, practice managers and certified coders developing training to fit specific provider's needs.


The 10-15 direct reports will be assigned to providers based on data analysis indicating where they need support/training on documentation improvement and coding accuracy. The team at large will be accountable for the following functions:


  • Assist providers in understanding the Medicare quality (HEDIS / STARS) program as well as CMS-HCC Risk Adjustment program as it relates to payment methodology and the importance of proper chart documentation of procedures and diagnosis coding

  • Utilize analytics and identifies and targets providers for Medicare Risk Adjustment training and documentation / coding resources

  • Responsible for facilitating and / or performing an audit of the providers’ medical chart to ensure appropriate documentation exists to support the diagnoses submitted appropriately

  • Assist providers in understanding quality and CMS-HCC Risk Adjustment driven payment methodology and the importance of proper chart documentation of procedures and diagnosis coding

  • Support the providers by ensuring documentation supports the submission of relevant ICD -10 codes and CPT2 procedural information in accordance with national coding guidelines and appropriate reimbursement requirements

  • Routinely consult with medical providers to clarify missing or inadequate record information and to determine appropriate diagnostic and procedure codes

  • Ensure member encounter data (services and disease conditions) is being accurately documented and relevant procedural codes and all relevant diagnosis codes are captured

  • Provide thorough, timely and accurate consultation on ICD-10 and / or CPT 2 codes by providers or practice clinical consultants

  • Refers inconsistent or incomplete patient treatment information / documentation to Coding Quality Analyst, provider, supervisor or individual department for clarification / additional information for accurate code assignment

  • Develops and delivers diagnosis coding tools to providers

  • Trains physicians and other staff regarding documentation, billing and coding and provides feedback to physicians regarding documentation practices

  • Educates providers and staff on coding regulations and changes as it relates to Quality and Risk Adjustment to ensure compliance with state and federal regulations

  • Performs analysis and provides formal feedback to providers on a regularly scheduled basis

  • Provides measurable, actionable solutions to providers that will result in improved accuracy for documentation and coding practices

  • Assesses adequacy of documentation and queries providers to obtain additional medical record documentation or to clarify documentation to ensure accurate and appropriate coding

  • Collaborates with doctors, coders, facility staff and a variety of internal and external personnel on a wide scope of Risk Adjustment and Quality education efforts

 Required Qualifications:

  • Bachelor’s degree
  • 4+ years progressively responsible business management experience in a high impact role (clinic or hospital or managed care)
  • 3+ years in one or more of these areas Medicare and other government program reimbursement methodologies: Resource Based Relative Value System, DRG, Groupers, Risk Adjustment, HEDIS, STARS, etc.
  • 3+ years of experience with clinical coding, risk adjustment or HEDIS / STARS
  • Proficient with Microsoft Word, Excel, PowerPoint, Outlook  


Preferred Qualifications:

  • Advanced degree

    RN, NP, PA

  • Ability to analyze data, develop business plans, devise a strategy on approaching provider groups on improving overall documentation and coding

    Experience in face to face interaction with Providers and staff to correct coding and documentation quality (adept at addressing issues without being confrontational)

  • Demonstrated leadership capability in developing new teams, growing existing business and the ability to lead and motivate people to achieve agreed-upon results

  • Strong strategic thinking capacity, effective communication skills and a proven track record of building and maintaining multiple effective partnerships

  • Sound negotiation skills and ability to build consensus regarding plans / ideas in driving mutually beneficial outcomes

  • Ability to prioritize multiple tasks, promote teamwork and fact based decision making

  • Ability to utilize financial modeling and analysis in making rate decisions in-depth knowledge of the contracting process, credentialing process, provider relations and network data management / systems

  • Strong problem solving skills with abilities to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action

  • Ability to communicate concisely conveying complex / technical information in a manner others can understand, as well as ability to understand and interpret complex information from others

  • Cross functional experience within clinical care operations, extensive knowledge of health care, provider and insurance industry  

  • Demonstrated success and deep understanding of Health Care delivery operations and compliance, health care financing an industry trends

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world?s large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)


Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Job Details

  • Contest Number758664
  • Job TitleDirector Clinical Coding & Education
  • Job FamilyMedical and Clinical Operations
  • Business SegmentOptumInsight

Job Location Information

  • MN
    United States
    North America

Additional Job Detail Information

  • Employee StatusRegular
  • ScheduleFull-time
  • Job LevelDirector
  • ShiftDay Job
  • TravelYes, 25 % of the Time
  • Telecommuter PositionYes
  • Overtime StatusExempt

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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