Coding Quality Analyst – Remote

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 (40 hours/week) 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 – 5:00pm CST. It may be necessary, given the business need, to work occasional overtime.

 

We offer 2 weeks of on-the-job training. The hours of the training will be aligned with your schedule.

 

You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

 

Primary Responsibilities: 

• Performs clinical review 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 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
• Provides detailed clinical narratives on case outcomes
• Perform claim recoding
• 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
• Certified Coder AHIMA (CCS, CCS-P) or AAPC Certified coder (CPC, CPC-I) or Nurse (RN, LPN) with unrestricted license, or currently in coding academy (internal)
• 2+ years of experience as an AHIMA or AAPC Certified coder with 2+ years of CPT/HCPCS/ICD – 10/CM/PCS coding experience or Licensed nurse with medical record auditing and coding/billing experience
• 1+ years of working in a team atmosphere in a metric driven environment including daily production standards and quality standards
• Experience must include CPT/HCPCS/Modifiers (Medical necessity and DRG review experience is not applicable to this position)
• Medical record review experience
• Intermediate experience with Microsoft & Adobe applications (Outlook, Power Point, Word, Excel, OneNote, Teams, PDF)
• Knowledge of health insurance business, industry terminology, and regulatory guidelines
• Understanding of Waste & Error principles 
• Must be 18 years of age OR older
• Demonstrated ability to work full-time, 8:00am – 5:00pm CST including the flexibility to work occasional overtime given the business need

 

Preferred Qualifications:

• Healthcare claims experience/processing experience
• Experience with Fraud Waste & Abuse or Payment Integrity
• Proven analytical mindset working with medical terminology or coding

 

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 

 

The hourly range for this role is $xx.xx to $xx.xx per hour based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. 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.

 

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.