Clinical Quality Analyst

Optum · Bangor, ME · 3 wk ago

Quality Assurance$29–$52/hrFull-time

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
Possess strong collaboration skills, partnering 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
Provide targeted education and follow-up audits for providers who do not meet established quality standards
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
Provide 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 surgical coding experience in Evaluation and Management plus one or more of the following: Neurology + one or more of the following, Breast Surgery, Dermatology, Endocrinology, Gastroenterology, Oncology, Opthalmology, Optometry, Oral Surgery, Otorhinolaryngology, Pain Management, Physiatry, Podiatry, Pulmonary Medicine, Rheumatology, Sleep Medicine, Urology, Vascular Care, Wound Care
2+ years of experience being able to provide 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

Experience auditing charts in a professional coding environment
Experience providing physician/coding education a plus
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

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).

The hourly pay for this role will range from $29.00 to $52.00 per hour based on full-time employment.

We comply with all minimum wage laws as applicable.

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

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.

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.

#RPO, #GREEN

Benefits