Coding Quality Analyst

About the role

The Coding Quality Analyst at Optum works to ensure healthcare claims are coded accurately according to regulatory requirements and payer policies. This role involves reviewing medical records, preparing documentation, and providing guidance to the investigation team.

Responsibilities

• Conduct coding reviews of medical records and supporting documentation against submitted claims
• Process and/or review claims in a timely manner utilizing client specific coding and billing requirements
• Participate in process improvement activities and encourage ownership of and group participation in improvement initiatives
• Analyze medical documents to evaluate potential issues of fraud and abuse
• Document coding review findings within investigative case tracking system and maintain thorough and objective documentation of findings
• Serve as a coding resource and provide coding expertise and guidance to the entire investigation team
• Identify and recommend opportunities for cost savings and improving outcomes
• Coordinate activities with varying levels of leadership including the investigative team, legal counsel, internal and external customers, law enforcement and regulatory agencies, and medical professionals through effective verbal and written communications as needed
• Research and interpret correct coding guidelines and internal business rules to respond to customer inquiries, and monitor CMS and major payer coding and reimbursement policies

Requirements

• High School Diploma/GED
• One or more of the following coding credentials: RHIA, RHIT, CCS-P, CCS, CPC, or COC
• 3+ years of experience in medical coding with primary focus in facility and physician coding
• 3+ years of experience in reviewing, analyzing, and researching coding issues
• Intermediate level of proficiency in Microsoft Office skills including Outlook, Excel, and Word (Open/Edit/Create/Save/Send)
• Able to work full-time, Monday - Friday between 6:00am - 6:00pm including the flexibility to work occasional overtime given the business need

Qualifications

• Associate degree (or higher) OR equivalent in Health Information Management
• Experience with reimbursement policy and/or claims

Preferred Qualification

• Telecommuting requirements

Soft Skills

• Self-starting and independent
• Able to stay focused while working remotely
• Establish good customer relationships with trust and respect
• High level of attention to written communication

Pay and Benefits

• Hourly pay range: $24.00 to $43.00 per hour
• Comprehensive benefits package including paid time off, medical, dental, vision, life & AD&D insurance, short-term and long-term disability, 401(k), employee stock purchase plan, and education reimbursement
• Equity stock purchase and 401k contribution

UnitedHealth Group's Commitment

At UnitedHealth Group, we are committed to helping people live healthier lives and making the health system work better for everyone. We are dedicated to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes.