Quality Assurance Specialist

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.  

Primary Responsibilities:

• Be able to perform QA audits for multiple projects
• Derive effective QA sampling & audit methodology for the projects assigned
• Possess analytical skills to monitor & measure the quality trend in the coding projects
• Perform root cause analysis, identify knowledge gaps, and conduct training to project team
• Review scope document & guidelines for new clients before the start of the project and own pilot 
• project delivery to meet client SLA on quality
• Review & customize standard coding guidelines as needed
• Identify error trends on client feedback & improve client experience by continuous improvements
• Conduct training sessions on audit protocols, the comment matrix, and best practices for prospective auditors
• Be able to respond to the internal coding queries with proper rationale
• Follow external and internal compliance standards
• Comply with the terms and conditions of the employment contract, company policies and procedures, and any and all directives (such as, but not limited to, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regards to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment). The Company may adopt, vary or rescind these policies and directives in its absolute discretion and without any limitation (implied or otherwise) on its ability to do so

Required Qualifications:

• Educational Background: Degree in Life Sciences or Medical/Paramedical Sciences
• Certifications: Valid AAPC or AHIMA certification is required
• Experience: 3+ years of experience HCC Risk Adjustment Coding
• Knowledge on risk adjustment models – Medicare & Commercial
• Well-versed in coding standards and guidelines, including ICD-10-CM guidelines, AHA coding clinic updates, and client-specific guideline requirements

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.