Coding Quality Analyst SME

About the Role

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.

Responsibilities

• Ensure accurate and timely coding reviews with a focus on compliance and education.
• Perform daily account reconciliations and audit management.
• Collaborate with coding and clinical teams.
• Conduct prebill reviews and resolve coding disputes.
• Perform coding quality audits and provide coder education.
• Maintain client coding guidelines annually.
• Support various meetings and assist in agenda preparation.
• Provide coverage for other SMEs as needed.
• Keep coding quality workflows moving and resolve escalations quickly.
• Support coders with education and guidance.
• Maintain client-specific standards.
• Participate in recurring quality-related meetings.

Requirements

• High School Diploma/GED.
• Professional coder certification with credentialing from AHIMA and/or AAPC (CPC, CCS-P, RHIA, RHIT) to be maintained annually.
• 4+ years of experience in revenue cycle operations, specifically Coding and HIM (Health Information Management) support.
• 2+ years of Acute outpatient coding experience.
• Experience with Microsoft Office products.

Preferred Qualifications

• Working knowledge of all areas of the revenue cycle.
• Detailed knowledge of HIM, Coding, including physician query processes, clinical chart reviews, deficiency analysis, scanning, coding, medical record correction processes, denials, and regulations governing HIM core functions.
• Proven exposure to EPIC, Meditech, and 3M Solventum.
• Solid organizational skills, working effectively in a multi-task-based environment, and ability to work both independently and collaboratively.
• Proven leadership, communication, problem-solving, and decision-making skills.

Pay

The hourly pay for this role will range from $29.00 - $52.00 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.

Benefits

• Comprehensive benefits package.
• Incentive and recognition programs.
• Equity stock purchase.
• 401k contribution (all benefits are subject to eligibility requirements).