Identify appropriate assignment of CPT and ICD 10 Codes for outpatient surgery, observation, CVIR, emergency, and ancillary services while adhering to the official coding guidelines and established client coding guidelines of the assigned facility Apply coding knowledge to analyze/correct CCI Edits and Medical Necessity accounts Understand the Medicare Ambulatory Payment

Serve as a member of the operations senior leadership team and advise executives on external trends, problems, and activities to facilitate both short and long range strategic plans to improve operational performance and enhance growth. Set the vision and strategic plan for OptumRx PBM operations & client services and support scaled operations through solid partnership ac

This position is to secure the IBMi servers and the applications to prevent unauthorized access to client data, system configurations, application function, communications between servers and applications This position will also help provide evidence for the various audits that take place such as ICFR, SOC, HITRUST and client or state required audits In addition, this pos

Make determinations of medical necessity/clinical appropriateness of treatment Assist in the development and implementation of clinical policy, guidelines and applications Regularly contact providers whose treatment determinations indicate a trend that varies with their peers and community Be knowledgeable on and apply all necessary regulatory requirements for assigned re

Make determinations of medical necessity/clinical appropriateness of treatment Assist in the development and implementation of clinical policy, guidelines and applications Regularly contact providers whose treatment determinations indicate a trend that varies with their peers and community Be knowledgeable on and apply all necessary regulatory requirements for assigned re

Raise the bar on excellence in execution in terms of quality, timeliness, and scalability Take accountability for key engineering metrics of the platform specifically availability, reliability, and security Develop and evolve engineering and product roadmap of UAIS Collaborate across various lines of businesses as well as global locations to ensure smooth execution of cri

Deploy machine learning models and establish automated data pipelines between cloud and on premise environments Design and implement integration and unit tests to ensure system reliability and performance Continuous integration and continuous delivery of production code Develop code and system level documentation Work with the broader technical team to scope engineering m

Make determinations of medical necessity/clinical appropriateness of treatment Assist in the development and implementation of clinical policy, guidelines and applications Regularly contact providers whose treatment determinations indicate a trend that varies with their peers and community Be knowledgeable on and apply all necessary regulatory requirements for assigned re

Collaborate cross organizationally in the development, proposing and prioritization of customer solutions to reduce trend (programs, processes, benefit design, network, etc.) Works with business partners to ensure are aligned with successfully achieving savings targets Development and execution of cross functional strategies, projects and tactics which result in increment

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 diversity and inclusion, talented peers, c

Facilitate onboarding, upskilling, continuing education, and performance improvement training in a virtual environment Provide feedback to operations managers regarding class progress, areas of strength, and areas of improvement Develop training materials using appropriate mediums (virtual facilitation, blended learning, job support, elearning, etc.) Maintain a high degre

Design and develop onboarding, upskilling, continuing education, and performance improvement training using appropriate mediums (e learning, virtual facilitation, blended learning, job support, etc.) Maintain a high degree of accuracy and attention to detail Follow industry standard design and delivery process model(s) for assigned projects Meet deadlines and effectively

Serves as the clinical liaison with clinical performance and administrative staff as well as providing expertise solving member issues Makes outbound calls to assess members' current health status, as well as take inbound calls to resolve inquiries and assist members as needed. Warm transfer to other departments or services as needed Assesses patient needs using establish

Record monthly journal entries for asset, liability, revenue, and expense transactions Perform monthly account reconciliations for asset and liability accounts Support general ledger close processes including consolidating, maintaining, and reconciling accounts Prepare monthly customer invoices Produce clear, well formed documentation to communicate results and conclusion

Familiarity with SMF/RMF record structures Ability to work with SAS programming and statistical data Utilize knowledge of large scale operational and system concepts Develop and maintain system performance reporting using MXG, SAS, and Splunk Monitor daily system health for areas of improvement and exceptions Deliver recommendations for enhancing performance Perform probl