Coding Quality Analyst – 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 diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

The Coding Quality Analystis required to determine the accuracy of claims submitted by a provider to UnitedHealth Group by comparing it to the medical record(s) submitted for the date(s) of service being reviewed. They must be able to exercise judgement / decision making on complex payment decisions that directly impacts the provider and UHC / Client by following state and government compliance guidelines, coding requirements and policies. They must confidently analyze and interpret data and medical records / documentation on a daily basis to understand historical claims activity, determine validity and demonstrate their ability to provide written communication to the provider. They are responsible to investigate, review and provide clinical and / or coding expertise in a review of pre – payment claims. They need to effectively manage their caseload and monthly metrics in a production driven environment and ensure they are meeting all compliance turnaround times mandated by the client. The Coding Quality Analyst must be proficient in computer skills and able to navigate multiple systems at one time with varying levels of complexity. They must have the ability to research and work independently on making decisions on complex cases.

This position is full-time. Employees are required to work our normal business hours of 8:00 AM – 4:30 PM.

We offer weeks of on-the-job training. The hours during training will be 8:00 AM – 4:30 PM from Monday – Friday. Training will be conducted virtually from your home.

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

Primary Responsibilities:

• Performs quality audits of clinical review cases of CPT, HCPCS, and modifiers assigned to codes on claims in a telecommuting work environment.
• Determines accuracy of medical coding / billing and payment recommendation for pre – payment claims.
• This could include Medical Director / physician consultations, interpretation of state and federal mandates, applicable benefit language, medical and reimbursement policies and consideration of relevant clinical information.
• Determines appropriate level of service utilizing Evaluation and Management coding principles.
• Ensures adherence to state and federal compliance policies, reimbursement policies and contract compliance.
• Identifies aberrant billing patterns and trends, evidence of fraud, waste or abuse, and recommends providers to be flagged for review.
• Maintains and manages daily case review assignments, with accountability to quality, utilization and productivity standards.
• Provides clinical support and expertise to the other investigative and analytical areas.
• Participates in team and department meetings.
• Engages in a collaborative work environment when applicable but is also able to work independently.
• Serves as a clinical resource to other areas within the clinical investigative team.
• Work with applicable business partners to obtain additional information relevant to the clinical review.

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 
• 2+ years of experience as an AHIMA OR AAPC Certified coder with 2+ years of CPT / HCPCS / ICD – 10 / CM / PCS coding experience
  • Experience must include CPT / HCPCS / Modifiers (Medical necessity and DRG review experience is not applicable to this position)
• 1+ years of experience with working in a team atmosphere in a metric – driven environment, including daily production standards and quality standards
• Certified Coder AHIMA OR AAPC Certified coder (CPC, CCS, CCS – P) with medical record auditing and coding / billing experience
• Medical record review experience
• Knowledge of health insurance business, industry terminology, and regulatory guidelines
• Computer skills with the ability to troubleshoot problems
• Basic (or higher) experience with using Microsoft (Microsoft Word, Microsoft Excel, Microsoft PowerPoint, Microsoft Outlook) & Adobe applications (PDF)
• Ability to work any shift between the hours of 8:00 AM – 4:30 PM
• Must be 18 years of age OR older

Preferred Qualifications:

• Healthcare claims experience / processing experience
• Communication skills with the ability to interpret data
• Experience with Fraud, Waste, & Abuse OR Payment Integrity
• Experience in working with medical terminology OR coding, with an analytical mindset

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

Soft Skills:

• Proficiency and ability to navigate and maneuver multiple systems at one time with varying levels of complexity

Physical and Work Environment

• frequent speaking, listening using headset, sitting, use of hands / fingers across keyboard

California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Washington, or Rhode Island Residents Only: The hourly range for California / Colorado / Connecticut / Hawaii / Nevada / New York / New Jersey / Washington / Rhode Island residents is $23.22 – $45.43 per hour. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

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.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity / Affirmative Action employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug – free workplace. Candidates are required to pass a drug test before beginning employment.

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