Coding Quality Analyst - National Remote at Optum

You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

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, comprehensive benefits, and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.  

An Coding Quality Analyst serves as a resource to others while performing peer-to-peer overreads on a daily basis. This role will have assignments of projects where deadlines and scope shift frequently. Coding Quality Analyst oversees the quality of main-line coding practices under the direction of their respective manager.

Positions in this function are responsible for providing expertise or general support in reviewing, researching, investigating, negotiating and resolving all types of appeals and grievances. Communicates with appropriate parties issues, implications and decisions. Analyzes and identifies trends for appeals and grievances. The Medical Coder will be responsible for processing appeals and reviewing billings and medical records to determine the appropriateness of billings. The Medial Coder will also be involved in the provision of technical assistance to providers on correct coding.

This position is full time (40 hours/week) Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00am - 5:00pm. It may be necessary, given the business need, to work occasional overtime.

We offer 4 weeks of on-the-job training. The hours during training will 8:00am to 5:00pm and then candidate can work flexible shift after, Monday - Friday.  

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

Primary Responsibilities:

• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions:
• Accurately read and analyze CMS as well as client specific coding guidelines for peer-to-peer and vendor over-reads 
• Responsible for reviewing medical records previously coded by peer to determine and ensure accuracy, completeness, specificity, and appropriateness of diagnosis codes based on documentation in accordance with established CMS and client-specific guidelines for MRA and ACA coding.
• Prepares and presents written feedback to coding staff and upper management
• Current working knowledge of ICD-10-CM, CPT, HCPCS coding.
• Maintain accurate knowledge of coding compliance and reimbursement procedures related to top Medicare Risk Adjustment HCC’s.
• Requires a strong knowledge of diagnostic coding and HCC documentation requirements.
• Semi-flexible schedule with requirement of 40-hour work week.
• Support and participate in process and quality improvement initiatives, implementation/execution. You are good at organizing and managing multiple priorities and or projects by using appropriate methodologies and tools.
• Problem solving, you are a problem solver with the ability to encourage others in collaborative problem solving.
• Methodical and detail-oriented.
• Requires strong ability to work independently with minimum supervision, excellent reliability, positive attitude, and demonstrated ability to work timely and effectively under strict deadlines.
• Requires an individual to maintain the ability to work in an environment with PHI / PII data.
• May be assigned other duties.
• Must maintain compliance with all company policies and procedures.

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.

Required Qualifications:

• High School Diploma / GED
• Must be 18 years of age OR older
• 3+ years with Risk Adjustment coding and auditing experience.
• Certification from either AAPC and/or AHIMA (CPC, CCS, CRC or CPMA)
• Knowledge of coding industry standards and practices
• Experience with Microsoft Word (create correspondence and work within templates), Microsoft Excel (data entry, sort / filter, and work within tables) and Microsoft Outlook (email and calendar management)
• Computer proficiency with direct messaging applications (Microsoft Teams, Webex, etc.)
• Ability to train for the first 4 weeks between Monday – Friday, 08:00AM -05:00PM and then candidate can work flexible shift after.
• Ability to work full-time, Monday - Friday between 8:00am - 5:00pm including the flexibility to work occasional overtime given the business need

Preferred Qualifications:

• Experience with peer-to-peer reviews

Telecommuting Requirements: 

• Ability to keep all company sensitive documents secure (if applicable) 
• Required to have a dedicated work area established that is separated from other living areas and provides information privacy. 
• Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service. 

Soft Skills:

• Excellent Verbal and written communication skills, including ability to effectively communicate with internal and external customers.
• Ability and skill to maintain strong relationships with multiple stakeholders
• Ability to communicate with different professional levels
• Must be able to work under pressure and meet deadlines, while maintaining a positive attitude and providing exemplary customer service.
• Ability to work independently and carry out assignments to completion within parameters of instructions given, prescribed routines, and standard accepted practices.
• High level of ethics, integrity, discretion, and confidentiality.
• Knowledge of customer specifications.

California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Washington, Rhode Island, OR Washington, D.C. Residents Only: The hourly range for this is $23.22 - $45.43 per hour. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

 Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

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.

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.

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