Clinical Quality Analyst

Primary Responsibilities

• Serve as a liaison between coding teams and providers, delivering expert guidance to resolve inquiries and concerns
• Collaborate with Edits and Denials teams to analyze trends and implement educational initiatives or system edits to address recurring issues
• Partner with clinical leadership during the introduction of new services to ensure accurate documentation and coding compliance
• Participate in specialty and physician group meetings on a quarterly basis to provide targeted coding education and respond to ad hoc inquiries
• Deliver comprehensive coding and documentation training for all newly onboarded providers
• Provide annual education to providers on code set updates to maintain compliance and accuracy
• Conduct annual provider audits to validate charges and supporting documentation, while identifying potential revenue opportunities
• Perform ad hoc audits in response to client requests or identified concerns
• Deliver targeted education and follow-up audits for providers who do not meet established quality standards
• Assist coders and/or supervisors as needed on rebuttals for tri-annual audits

Required Qualifications

• High School Diploma/GED
• Professional coder certification with credentialing from AHIMA and/or AAPC (CPC, CCS-P, RHIA, RHIT) to be maintained annually
• 3+ years of Physician medical coding (ICD-10, CPT, HCPCS II) experience in a multi-specialty physician clinic
• 2+ years of experience with Residency Program (teaching hospital) with coding experience in Evaluation and Management plus one or more of the following: Urogynecology, ENT, and Dermatology
• 2+ years of experience providing expert level coding guidance to physicians, practitioners, and coders as needed
• Intermediate level of knowledge of MUE and NCCI classification and reimbursement structures
• Intermediate level of proficiency in a Windows PC environment, including MS Excel and with Epic
• Preferred qualifications include experience auditing charts in a professional coding environment, experience providing physician/coding education, experience with various systems (Microsoft Teams, Encoder Pro, etc.), experience in Inpatient/Observation E/M coding, intermediate level of experience with Microsoft Excel, and soft skills must be able to communicate effectively face-to-face and in writing

Preferred Qualifications

• Experience auditing charts in a professional coding environment
• Experience providing physician/coding education
• Experience with various systems (Microsoft Teams, Encoder Pro, etc.)
• Experience in Inpatient/Observation E/M coding
• Intermediate level of experience with Microsoft Excel

Soft Skills

• Must be able to communicate effectively face-to-face and in writing

Telecommuting Policy

Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.

Pay and Benefits

• Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc.
• In addition to your salary, we offer 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 us, you'll find a far-reaching choice of benefits and incentives.
• The salary for this role will range from $29 to $52 annually based on full-time employment.
• We comply with all minimum wage laws as applicable.

Equal Opportunity Employer

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.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

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

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