Clinical Quality Analyst

This position is National Remote. You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges. 

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. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

This position is full-time, Monday – Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00am – 4:30pm EST. It may be necessary, given the business need, to work occasional overtime.

We offer 4 weeks of on-the-job training. The hours of training will be aligned with your schedule.

Primary Responsibilities:

• Assesses and interprets needs of the Ambulatory Coding Team by prioritizing work to meet deadlines.
• Identifies solutions to non-standard edits, workflows, and issues.
• Solves complex questions and conducts analysis of trends to provide education for the coding staff and clients including physicians/providers.
• Provides detailed education to the Coding Team and acts as a resource to others.
• Train and review assignments completed by new employees and provide post-hire reviews as needed.
• Apply expert coding knowledge to professional coding and billing initiatives and inquiries.
• Identify appropriate assignment of ICD-10-CM, CPT, and HCPCS II Codes for physician services, while adhering to the official coding guidelines and established client coding guidelines of the assigned facility
• Understand the Medicare Ambulatory Payment Classification (APC) codes
• Adhere to the ethical standards of coding as established by AAPC and/or AHIMA
• Adhere to and maintain required levels of performance in both coding quality and productivity as established by Optum360
• Understand federal coding register and ensure guidelines are used and followed appropriately.
• Understanding of appeal process with knowledge how to speak to denial and/or appeals.
• Provide documentation feedback to providers and query physicians when appropriate
• Maintain up-to-date Coding knowledge by reviewing materials disseminated/recommended by the Compliance, Coding Operations, etc.
• Participate in coding department meetings and educational events
• Strong knowledge of coding clinics and how to obtain education information.
• Process Rebills as appropriate.
• Other duties at the discretion of the Coding Supervisor

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. 

Required Qualifications:

• High School Diploma / GED
• Professional coder certification with credentialing from AHIMA (RHIA, RHIT) and/or AAPC (CPC, CCS-P,) to be maintained annually
• Must be 18 years of age OR older
• 3+ years of physician (pro-fee) medical coding experience
• 2+ years of experience providing consultation and/or education to physicians and practitioners on coding guidelines and requirements
• Expert level coding experience with a mastery of complex procedures in one or more the following specialty areas: Cardiothoracic, Vascular and Cardiac Catheterizations, Orthopedics, Neurology, Neurosurgery, General Surgery, OB/GYN, Hospitalist, and other specialties may be applicable
• Intermediate proficiency in Microsoft Office Suite (Word, Excel, Outlook)
• Proficiency in EMR (Electronic Medical Records) software
• Experience with professional Inpatient and Outpatient E/M (evaluation management) coding
• Must have experience with ICD-10, CPT, and HCPCS II
• Ability to travel up to 10% as needed for business meetings in Pennsylvania
• Ability to work full-time, Monday – Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00am – 4:30pm EST. It may be necessary, given the business need, to work occasional overtime.

Preferred Qualifications:

• Expert level coding experience with a mastery of complex procedures in OB/GYN
• Experience auditing charts in a professional coding environment
• Experience with various Encoder systems
• Firm understanding of federal coding guidelines
• Understanding of appeals/denials process
• Knowledge of coding clinics and how to obtain educational information
• Intermediate knowledge of OCE, MUE and NCCI classification and reimbursement structures

Telecommuting Requirements:

• Ability to keep all company sensitive documents secure (if applicable)
• Required to have a dedicated work area established that is separated from other living areas and provides information privacy.
• Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service.

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy  

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 hourly pay for this role will range from $28.27 – $50.48 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

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.