Quality Assurance Specialist

Opportunities with Episource, part of the Optum family of businesses. Join a premier provider of risk adjustment services, software and solutions that’s fueling innovation in the health care industry. Start a rewarding career where your work will empower health plans and medical groups with comprehensive end-to-end solutions designed to navigate health care efficiently. Our culture is rooted in innovation, encouraging our team to stay curious and engaged. By joining us, you become part of a global, remote/hybrid-friendly team dedicated to bridging health care gaps with a solid sense of social responsibility. At Episource, we are enriching lives, including those of our team members through Caring. Connecting. Growing together.

Primary Responsibilities:

• Derive effective QA sampling & audit methodology for the projects assigned
• 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
• Ability 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:

• 4+ of medical Coding experience
• Worked at least 1+ year as an SME/QA
• AAPC/AHIMA Certification
• Knowledge on risk adjustment models – Medicare, Commercial & Medicaid
• Experience in any coding specialty is preferred to handle the pilot projects
• Proven well-versed in coding standards and guidelines, including ICD-10-CM guidelines, AHA coding clinic updates, and client-specific guideline requirements
• Ability to perform QA audits for multiple projects
• Proven analytical skills to monitor & measure the quality trend in the coding projects
• Solid knowledge in Anatomy & Physiology

Preferred Qualification:

• Risk Adjustment Coding experience

Personal Attributes/Job Specific Competencies:

• Effective Planning – Competent
• Goal/Objective Setting – Competent
• Decision Making – Competent
• Report Writing – Competent
• Interpersonal Skills – Competent
• Communication – Competent
• Reading and Comprehension – Advanced
• Taking Initiatives – Competent
• Teamwork & Team Building – Basic

Ability Level:

• Expert – Fully conversant with all applications of the skill/knowledge in a range of environments / would be recognized by others as expert in this skill / could be expected to train others in this skill
• Advanced – Thorough understanding of skill/knowledge area / able to pass on skills in this area / recognized by colleagues as having proven skill / knowledge in this area
• Competent – Sufficient skill to apply in a day-to-day operations in a fluctuating environment / does not require supervision for routine tasks
• Basic – Limited understanding of skill/knowledge area. Sufficient to perform basic tasks

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.