Coding Quality Analyst

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.

About the role

The Coding Quality Analyst will accurately and efficiently review and extract pertinent case details from patient medical records; and craft strongly defensible appeal letters per process instructions and the department's/company's guidance. They will have a working knowledge of encoder use and selecting appropriate, supportable appeal arguments from evidence-based, peer-reviewed medical literature as provided, as well as interpreting and utilizing ICD-9 and 10, CM and PCS, CPT coding system, and HCPCS guidelines. They will recommend changes to coding which will retain, lessen, or increase financial impact when analysis of chart indicates opportunities. They will educate clients on correct coding and compliance for best practices. They will participate in ALJ (Administrative Law Judge) hearings as representatives of the clients during tele-hearings. The Coding Quality Analyst will complete their case within the time expectations while providing high-quality reviews. You will enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Responsibilities

• Adhere to approved schedule and arrive at work timely
• Maintain accurate accounts of time off in both Verint and HR Direct as per guidelines, and follow directives for time off, schedule changes, etc.
• Compose appeal letters to include appropriate data extraction, construction of well-written appeals letters with proper grammar, utilization of appeal tools including pre-constructed templates, and inclusion of appropriate medical literature references
• Use and demonstrate fluency with encoders, coding clinics, ICD-9 and 10 guidelines, CM and PCS, CPT coding system, and HCPCS guidelines
• Understand and comply with HIPAA confidentiality requirements
• Support and promote OPAS, Optum, and the enterprise goals and mission
• Build relationships across Optum, OPAS, OGA, and clients
• Collaborate with peers to assure continuity of communication and execution of deliverables as needed
• Adhere to quality and productivity expectations
• Participate in and contribute to meetings as appropriate
• Maintain organization on the team and ensure everyone conducts themselves professionally
• Remain up to date with all learning modules, competencies, and state-required licenses
• Perform other related duties, tasks, and processes as required by leadership
• Establish priorities, be self-motivated, work independently, and follow instructions with supervision and structure
• Maintain a positive attitude and the ability to function as a collaborative team member

Requirements

• High School Diploma/GED
• Possess one of the following coding certifications: CCS, CCS-P, CPC-H, CPC, RHIT, RHIA, CDIP, CCDS
• 3+ years of Inpatient Hospital Coding experience
• 3+ years of experience with DRG methodology
• 3+ years of outpatient coding experience
• 2+ years of Medicare/Medicaid experience
• Mastery level of knowledge of AHA Coding Clinic for ICD-9-CM and ICD-10
• Intermediate level of computer proficiency with strong typing skills (minimum of 45 wpm)

Preferred Qualifications

• Associate's or Bachelor's Degree
• Unrestricted RN license required in state of residence
• 3+ years of experience in ED, Telemetry, CCU
• Auditing experience
• Experience with Microsoft applications and software, internet navigation, and utilization
• Previous experience with presenting before Administrative Law Judge

Skills

• Strong, effective verbal and written communication skills

Benefits

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).

Pay

The hourly pay for this role will range from $23.89 to $42.69 per hour based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, and certifications. We comply with all minimum wage laws as applicable.

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