Talent.com
Associate Director - Medical Coding
Associate Director - Medical CodingConfidential • Hyderabad / Secunderabad, Telangana, India
Associate Director - Medical Coding

Associate Director - Medical Coding

Confidential • Hyderabad / Secunderabad, Telangana, India
17 days ago
Job description

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

  • Monitor quality activities to increase departmental accuracy and efficiency, including but not limited to planning, development, and implementation of improvement areas
  • Review analysis of audit findings quality trends and noncompliance issues detected through auditing
  • Collaborate with team supervisors to develop best practices for communicating areas of improvement
  • Manage the implementation of proactive solutions to mitigate risk that will impact project quality
  • Incorporate feedback from operational and QA reports to improve performance
  • Assesses, evaluates, and addresses variance in production and key goals for operations
  • Participates in team meetings / discussions of quality trends reported by team members
  • 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 regard 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

Functional Competencies

  • GOM_ Plan / Implement / Manage Medical Coding Quality Programs and Strategies
  • Develop and tailor quality improvement plans aligned with regulatory and payer requirements
  • Analyze client contracts, coding guidelines, and payer policies to incorporate into operational plans
  • Support internal teams and external partners in resolving coding-related issues and ensuring accurate implementation of coding protocols
  • Establish and monitor service level agreements (SLAs) for coding accuracy, turnaround time, and audit responsiveness
  • Identify and secure resources (e.g., certified coders, audit tools, training platforms) necessary for program success
  • Review and optimize coding workflows to ensure compliance, efficiency, and scalability
  • Provide expert guidance to cross-functional teams (e.g., coding, OpX, compliance) to ensure coding strategies are effectively implemented
  • Interpret regulatory and contractual coding requirements to support accurate documentation and reimbursement
  • GOM_Monitor / Evaluate Medical Coding Quality Program Performance
  • Collect feedback from stakeholders to assess the effectiveness of coding quality initiatives
  • Monitor coding accuracy, audit outcomes, and compliance metrics against SLAs and industry benchmarks
  • Collaborate with internal teams (e.g., coding, OpX, compliance) to produce accurate performance reports
  • Utilize dashboards and scorecards to track coding quality trends and identify areas for improvement
  • Validate and analyze coding data to ensure accuracy and completeness
  • Review consolidated performance reports to identify gaps, recommend corrective actions, and explore opportunities for program expansion
  • Integrate coding performance insights into strategic planning and operational forecasting
  • Delegate post-implementation tasks to ensure contractual and regulatory obligations are met
  • Analyze coding performance using key indicators (e.g., RADV, OIG audits
  • GOM_Build / Maintain / Manage Relationships with Coding Operations and Compliance Stakeholders
  • Develop a deep understanding of stakeholder roles across coding, compliance, clinical, and revenue cycle teams
  • Provide regular performance updates through scorecards and audit summaries
  • Lead recurring meetings (e.g., quality reviews, audit debriefs) to discuss coding accuracy, compliance issues, and improvement plans
  • Create and manage corrective action plans to address coding discrepancies and audit findings
  • Conduct in-depth reviews with stakeholders to identify continuous improvement opportunities
  • Ensure stakeholders are informed of updated coding guidelines, payer policies, and regulatory changes
  • Collaborate with internal and external partners to develop coding strategies that support quality, compliance, and financial goals.
  • GOM_Support / Develop / Ensure Compliance with Coding Policies, Procedures, and Regulations
  • Maintain up-to-date knowledge of coding standards (e.g., ICD-10, RA coding standards), payer guidelines, and regulatory requirements (e.g., CMS, OIG)
  • Educate staff on coding policies, documentation standards, and regulatory updates
  • Interpret and communicate contractual and regulatory coding requirements to ensure compliance
  • Contribute to the development and revision of coding policies and procedures
  • Ensure staff access and utilize current coding resources and regulatory updates
  • Track training completion and compliance with coding education requirements
  • Monitor and report coding compliance metrics (e.g., audit results, error trends) to internal and external stakeholders
  • GOM_Review / Manage / Drive Operations Efficiency, Quality, and Financial Performance
  • Leverage stakeholder feedback to drive continuous improvement in coding quality and operational efficiency
  • Ensure adherence to coding-related business and contractual obligations
  • Conduct end-to-end testing of coding workflows and systems to validate compliance and accuracy
  • Review and test business continuity plans related to coding operations
  • Use analytics tools to identify opportunities for coding process optimization
  • Demonstrate understanding of budgeting and forecasting as it relates to coding resource allocation and audit planning
  • Analyze budget variances and recommend adjustments to support coding quality initiatives
  • Collaborate with finance and compliance teams to forecast resource needs and support strategic planning
  • Assign coding quality projects based on team capacity, expertise, and performance metrics
  • Values Based Competencies

  • Integrity Value : Model and Ensure Ethical Behavior
  • Comply with Applicable Laws, Regulations and Policies
  • Demonstrate Integrity
  • Require Integrity and Ethical Behavior from Others
  • Compassion Value : Deliver Value to Customers
  • Maximize Customer Growth and Retention
  • Optimize the Customer Experience
  • Relationships Value : Lead and Develop People
  • Bring in the Right Talent
  • Develop People
  • Drive Employee Engagement
  • Foster Teamwork and Collaboration
  • Learn and Develop Self
  • Leverage Diversity and Inclusion
  • Relationships Value : Communicate Effectively
  • Communicate with Impact
  • Influence and Negotiate
  • Listen Actively
  • Present Effectively
  • Innovation Value : Lead Change and Innovation
  • Demonstrate Emotional Resilience
  • Implement Innovative Solutions
  • Manage Change
  • Performance Value : Drive Sound, Disciplined Decisions
  • Apply Financial Knowledge
  • Make Decisions to Drive Action
  • Performance Value : Drive High-Quality Execution
  • Communicate Clear Direction
  • Drive Operational Excellence
  • Manage Execution
  • Required Qualifications

  • 13+ years of leadership experience, including managing large, cross-functional teams in healthcare operations
  • 12+ years of specialized expertise in medical coding, with a solid focus on Risk Adjustment coding standards, methodologies, and compliance
  • Proven experience in overseeing clinical case reviews and RA coding audits, ensuring accuracy, completeness, and adherence to regulatory guidelines
  • Hands-on experience managing business operations related to :
  • Risk Adjustment Coding
  • Clinical Investigations
  • RX Revenue Cycle Management (RCM)
  • Provider Coding
  • Demonstrated ability to manage P&L responsibilities for business units, driving performance and cost optimization
  • Successfully led and scaled teams of 350+ FTEs, fostering a culture of quality, accountability, and continuous improvement
  • Solid Project Management capabilities, including planning, execution, and delivery of strategic initiatives in coding quality and compliance
  • 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.

    Skills Required

    Project Management, Medical Coding

    Create a job alert for this search

    Associate Director • Hyderabad / Secunderabad, Telangana, India

    Related jobs
    Associate Medical Director

    Associate Medical Director

    Continental Hospitals • Hyderabad, Republic Of India, IN
    Continental Hospitals stands out as one of the best hospitals in Hyderabad, distinguished by its commitment to adhering to national and international guidelines while offering an extraordinary aest...Show more
    Last updated: 30+ days ago • Promoted
    Novartis Healthcare - Associate Director - AI Infrastructure

    Novartis Healthcare - Associate Director - AI Infrastructure

    Novartis Healthcare Pvt. Ltd. • Hyderabad, India
    Job Posting Title Assoc.DDIT IES Cloud Engineering Job Description Summary : Responsible for designing and developing a cutting-edge AI...Show more
    Last updated: 12 days ago • Promoted
    Associate Director, Specimen Systems

    Associate Director, Specimen Systems

    Bristol Myers Squibb • Hyderabad, Republic Of India, IN
    BMS Hyderabad is an integrated global hub where our work is focused on helping patients prevail over serious diseases by building sustainable and innovative solutions. This important science, techno...Show more
    Last updated: 13 hours ago • Promoted • New!
    Manager Operations RCM- Medical coding

    Manager Operations RCM- Medical coding

    Confidential • Hyderabad / Secunderabad, Telangana
    We are seeking a highly skilled and experienced Manager of Operations for our Revenue Cycle Management (RCM) department, specializing in medical coding. The ideal candidate will have extensive exper...Show more
    Last updated: 17 days ago • Promoted
    Associate Director- Quality(US Healthcare)

    Associate Director- Quality(US Healthcare)

    Confidential • Hyderabad / Secunderabad, Telangana, India
    Firstsource Solutions is a leading provider of customized Business Process Management (BPM) services.Firstsource specializes in helping customers stay ahead of the curve through transformational so...Show more
    Last updated: 17 days ago • Promoted
    Associate Director - Data Analytics Services

    Associate Director - Data Analytics Services

    Confidential • Hyderabad / Secunderabad, Telangana, India
    At Lilly, we unite caring with discovery to make life better for people around the world.We are a global healthcare leader headquartered in Indianapolis, Indiana. Our employees around the world work...Show more
    Last updated: 30+ days ago • Promoted
    Associate Director Director Healthcare Delivery & Solutions

    Associate Director Director Healthcare Delivery & Solutions

    Genzeon Global • Hyderabad, Telangana, India
    Associate Director / Director - Healthcare Delivery & Solutions.Healthcare Technology & Digital Solutions.We are seeking an accomplished Associate Director or Director to lead our healthcar...Show more
    Last updated: 30+ days ago • Promoted
    Associate Director - Data Platforms

    Associate Director - Data Platforms

    Confidential • Hyderabad / Secunderabad, Telangana, India
    Amgen harnesses the best of biology and technology to fight the world's toughest diseases, and make people's lives easier, fuller, and longer. We discover, develop, manufacture, and deliver innovati...Show more
    Last updated: 15 days ago • Promoted
    Associate Director, Biostatistical Programming

    Associate Director, Biostatistical Programming

    Confidential • Hyderabad / Secunderabad, Telangana, India
    HOW MIGHT YOU DEFY IMAGINATION.If you feel like you're part of something bigger, it's because you are.At Amgen, our shared mission—to serve patients—drives all that we do.It is key to our becoming ...Show more
    Last updated: 6 days ago • Promoted
    Medtronic - Associate Program Director

    Medtronic - Associate Program Director

    Medtronic (Medtronic)(279) • Hyderabad, India
    Description : At Medtronic you can begin a life-long career of exploration and innovation, while helping champion healthcare access and equity for all.Youll lead with...Show more
    Last updated: 30+ days ago • Promoted
    Associate Director - Database Platform Services

    Associate Director - Database Platform Services

    Confidential • Hyderabad / Secunderabad, Telangana, India
    At Lilly, we unite caring with discovery to make life better for people around the world.We are a global healthcare leader headquartered in Indianapolis, Indiana. Our employees around the world work...Show more
    Last updated: 30+ days ago • Promoted
    Associate Director Operational Excellence LDC

    Associate Director Operational Excellence LDC

    Confidential • Hyderabad / Secunderabad, Telangana, India
    As the Operational Excellence Associate Director for Lean Digital Core (LDC) in MEOG team, you will lead the design, implementation, and continuous improvement of Medical.Your mission is to drive p...Show more
    Last updated: 17 days ago • Promoted
    Director - Middle Operations - Medical Coding

    Director - Middle Operations - Medical Coding

    PRACTOVA TECHNOLOGY LLP • Hyderabad, India
    Title : Director - Middle Operations Location : Hyderabad Experience : 12-15 years &l...Show more
    Last updated: 12 days ago • Promoted
    BU Master Data Associate Director - Dev

    BU Master Data Associate Director - Dev

    Confidential • Hyderabad / Secunderabad, Telangana, India
    At Lilly, we unite caring with discovery to make life better for people around the world.We are a global healthcare leader headquartered in Indianapolis, Indiana. Our employees around the world work...Show more
    Last updated: 13 days ago • Promoted
    Associate Director, Biostatistical Programming

    Associate Director, Biostatistical Programming

    Accordion India • Hyderabad, Republic Of India, IN
    Company Overview Accordion is a global private equity-focused financial consulting firm specializing in driving value creation through services rooted in Data & Analytics and powered by technology....Show more
    Last updated: 13 hours ago • Promoted • New!
    Associate Director / Director - Healthcare Delivery & Solutions

    Associate Director / Director - Healthcare Delivery & Solutions

    Confidential • Hyderabad / Secunderabad, Telangana, India
    We are seeking an accomplished Associate Director or Director to lead our healthcare delivery portfolio with deep domain expertise and technical acumen. This strategic leadership role requires a uni...Show more
    Last updated: 17 days ago • Promoted
    BU Integrated Data Associate Director - Ops

    BU Integrated Data Associate Director - Ops

    Confidential • Hyderabad / Secunderabad, Telangana, India
    At Lilly, we unite caring with discovery to make life better for people around the world.We are a global healthcare leader headquartered in Indianapolis, Indiana. Our employees around the world work...Show more
    Last updated: 30+ days ago • Promoted
    Associate Director EEE Governance

    Associate Director EEE Governance

    Confidential • Hyderabad / Secunderabad, Telangana, India
    Primary Location : Hyderabad, India.Novartis is unable to offer relocation support for this role : please only apply if this location is accessible for you. Step into a pivotal role where your experti...Show more
    Last updated: 17 days ago • Promoted