Clinical Quality Analyst - National Remote

About the position

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. 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 EST. We offer 4 weeks of on-the-job training. The hours of the training will be aligned with your schedule. You'll enjoy the flexibility to telecommute from anywhere within the U.S. as you take on some tough challenges.

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.

Requirements

• High School Diploma / GED
• Professional coder certification with credentialing from AHIMA and/or AAPC & to be maintained annually
• Must be 18 years of age OR older
• 2+ years of cardiothoracic and vascular medical coding experience including outpatient & inpatient setting
• Must be able to provide expert level coding guidance to coders and coding leadership as needed
• Ability to use a PC in a Windows environment, including Microsoft Excel
• Ability to work Monday - Friday, 08:00AM - 05:00PM EST

Nice-to-haves

• Coding certification with one of the following (CPC, CCS-P, RHIA, RHIT etc.)
• Experience with evaluation & management coding
• Experience auditing charts in a professional coding environment
• Experience providing physician/coding education

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution