Clinical Quality Analyst

UnitedHealth Group•Tampa, FL

2h•$29 - $52•Remote

About The Position

This position is National Remote. You’ll enjoy the flexibility to telecommute from anywhere within the U.S. as you take on some tough challenges. Opportunities at Northern Light Health, in strategic partnership with Optum. Whether you are looking for a role in a clinical setting or supporting those who provide care, we have opportunities for you to make a difference in the lives of those we serve. As a statewide health care system in Maine, we work to personalize and streamline health care for our communities. If the place for you is at a large medical center, a rural community practice or home care, you will find it here. Join our compassionate culture, enjoy meaningful benefits and discover the meaning behind: Caring. Connecting. Growing together. This position is full time (40 hours / week), Monday - Friday. Employees have a lot of flexibility however the normal business hours are of 8:00 am - 5:00 pm EST. It may be necessary, given the business need, to extend hours and work occasional overtime or weekends as needed. This will be on the job training and the hours during training will be aligned with your schedule. Training will be conducted virtually from your home.

Requirements

High School Diploma / GED or equivalent work experience
AAPC or AHIMA (CCS, CPC, RHIT or RHIA) coding credential
Must be 18 years or older
5+ years of recent experience with IP coding and/or in a coding reviewer role
1+ years of experience working collaboratively with CDI and Quality leadership in partnership to improve reimbursement and coding accuracy
Intermediate level of proficiency with Microsoft Excel, Word, PowerPoint, and SharePoint
Intermediate level of proficiency with computer assisted coding technologies and EMR (Electronic Medical Record) coding workflow
Ability to work full time (40 hours / week), Monday - Friday. Employees have a lot of flexibility however the normal business hours are of 8:00 am - 5:00 pm EST. It may be necessary, given the business need, to extend hours and work occasional overtime or weekends as needed

Nice To Haves

5+ years of experience in related field
Ability to work with a variety of individuals in executive, managerial and staff level positions. The incumbent frequently interacts with staff at the Corporate/National, Regional and Local organizations. May also interact with external parties, such as financial auditors, third party payer auditors, consultants, and various hospital associations
Operational knowledge of health care related Federal and State regulations, as well as standards from regulatory agencies and accrediting organizations (e.g., CMS, TJC)
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
Excellent organizational skills (ability to multi-task, produce rapid turnaround, and effectively manage multiple projects)
Exemplary level ability to influence change and serve as primary change agent
Must possess a personal presence that is characterized by a sense of honesty, integrity, and caring with the ability to inspire and motivate others to promote the philosophy, mission, vision, goals, and values of Optum360 and our client organization(s)
All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

Responsibilities

Maintains and demonstrates expert knowledge of coding, coding operations, coding review of all coding staff (domestic and global) and best demonstrated coding practices; drives the integration of Optum360 Coding related business objectives within the client environment
Identifies & builds consensus for facilitation of system and process standardization, utilization of best practices, work integration, change management, issue resolution, metric development and measurement, and communication related to the key components of coding operations:
Executes the integration of the Optum360 Coding functions and processes in the facilities they serve
Leverages standard processes, systems, or other vehicles to reduce waste and cost at the facility while improving SLAs, KPIs (Key Performance Indicators), metrics and the overall client and/or patient experience
Works collaboratively with HIM, CDI, and Coding Operations to monitor day-to-day coding operations, prebill coding reviews, and prebill quality reviews
Assists Coding Leadership with oversight of processes and initiatives designed to continuously improve coding quality and/or efficiency
Maintains expert knowledge of coding to ensure high level of accuracy and proficiency standards of performance are achieved to meet or exceed targets
Effectively leads and participates in coding quality assurance/compliance activities that include action plans relevant to audit results including remediation, education, and when appropriate assisting to create and monitor corrective action plans internal audits for global partners
Serves as the liaison between the coding operations collaboratively bring each unit together including establishing, building, and maintaining cohesive relationships with the client
Effectively utilizes tools and data provided to capture and continually improve union, client, and employee engagement
Leads initiatives towards meeting and exceeding employee satisfaction
Leads by example; promotes teamwork by fostering a positive, transparent, and focused working environment which achieves maximum results
Participates actively in leadership forums at the system level and leads such forums and other informational/educational offerings for assigned HIM/Coding/CDI Managers
Provides team leadership and promotes successful business operation by: Fosters teamwork atmosphere between business and clinical stakeholders Provides staff training and mentoring Provides development of employees through consistent and constructive feedback geared towards accuracy Rewards and recognizes performance and provides leadership direction during the common review process Seeks to innovate and foster innovative ideas toward the development of staff to ensure increased employee engagement and employee satisfaction
Other duties as needed and assigned by Optum360 leadership, including but not limited to leading and conducting special projects. Develop project work plans, facilitate resource allocation, execute project tasks and obtain assistance from other intra and inter-departmental resources, as required
Subject Matter Expert of applicable Federal, State, and local laws and regulations, Optum360’s organizational integrity program, standards of conduct, as well as other policies and procedures to ensure adherence in a manner that reflects honest, ethical, and professional behavior
Promotes a service-oriented culture within the organization and assures satisfaction with the quality and amount of support provided for departmental functions, initiatives, and projects
Internal audits for global partners
All duties as assigned