Coding Strategy Lead - Remote

Overview

Optum Insight is improving the flow of health data and information to create a more connected system. We remove friction and drive alignment between care providers and payers, and ultimately consumers. Our deep expertise in the industry and innovative technology empower us to help organizations reduce costs while improving risk management, quality and revenue growth. Ready to help us deliver results that improve lives?

Join us to start Caring. Connecting. Growing together.

The Coding Strategy Lead serves as the primary Medical Coding Subject Matter Expert (SME) for Revenue Cycle Management (RCM) Center of Excellence. This role is responsible for developing and executing coding strategies, ensuring compliance with regulatory and coding changes, managing regulatory complaints, and maintaining a compliant charge master aligned with federal and state regulations. In addition, this position partners closely with Denial Prevention and Payer Solutions teams to address root causes of denials requiring coding expertise.

As a key leader within the organization, you will influence change across clinical and non-clinical teams at multiple levels and functions within one or more business units.

Success in this role will be measured by:

• Improved initial and final denial write-off rates
• Reduced accounts receivable (A/R) aging
• Decreased appeals

You will collaborate with operations to drive coding strategies for systemic billing issues impacting all MPP clients. Responsibilities include day-to-day operations management, oversight of escalated issues, development of resolution plans, risk mitigation, and creation of growth strategies through opportunity assessments. This role carries accountability for both financial and non-financial outcomes, requires regular client engagement, and ensures adherence to operational performance agreements and regulatory compliance.

Additional responsibilities include developing presentations and materials, prioritizing work queues, and creating contingency plans for missed deliverables. The role also leads regulatory complaint resolution and represents RCM Operations in Joint Operating Committee (JOC) calls with payers to address systemic misalignments.

You'll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges.

• Execute strategic plans in partnership with enterprise leadership, including short- and long-term coding strategies
• Lead implementation and strategy for regulatory complaint management within RCM Center of Excellence
• Represent RCM Operations as SME during JOC calls with payer partners
• Provide coding expertise during payer contract negotiations to address deficiencies
• Drive informed business decisions leveraging both clinical and coding knowledge
• Ensure achievement of key service level agreements (e.g., Initial Denial Rate, Final Denial Write-Off, Aging A/R, Appeal Overturns)
• Identify and remove operational barriers; conduct deep-dive program reviews to uncover improvement opportunities
• Promote continuous improvement in productivity and operational efficiency
• Partner to review, create, and maintain coding workflows to ensure accuracy and efficiency
• Provide guidance and expertise to internal and external partners for effective program implementation
• Interpret contractual requirements and communicate strategies to resolve issues
• Conduct regular stakeholder meetings to review updates, compliance audits, and operational challenges
• Develop corrective action plans to address stakeholder concerns and operational issues

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

• 8+ years in Revenue Cycle Management
• 8+ years of coding experience with certifications in both Professional and Facility Coding
• 5+ years influencing C-Suite decisions
• 3+ years using operational metrics, analytics, and dashboards to drive performance
• 3+ years of leadership experience across operational teams and functions
• Experience with line-item denials and policy
• Intermediate proficiency in Microsoft Office Suite (Word, PowerPoint, Excel, Outlook)
• Advanced Excel skills (filters, pivot tables, formulas)

• Experience in Payer - Managed Health Care
• Payment Integrity

• Ability to manage sensitive, escalated situations with internal and external customers
• Solid self-motivation and disciplined follow-through
• Highly collaborative with experience in growth strategy development and execution
• Ability to build credibility and relationships at all organizational levels
• Comfortable working in a matrixed, fast-paced environment with tight deadlines

All employees working remotely will be required to adhere to United Health Group's Telecommuter Policy

Pay is based on several factors including but not limited to local labor markets,…