Clinical Quality Analyst

UnitedHealth Group•Tampa, FL

5d•$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 are required to have flexibility to work during our normal business hours of 7:00 am - 6:00 pm. Must be flexible to attend client meetings per business needs during our client business hours of Monday - Friday, 7:00 am - 4:30 pm EST. It may be necessary, given the business need, to work occasional overtime. We offer weeks of on-the-job training. The hours of the training will be aligned with your schedule.

Requirements

High School Diploma / GED
Professional coder certification with credentialing from AHIMA and/or AAPC (CPC, CCS-P, RHIA, RHIT) to be maintained annually
Must be 18 years of age OR older
3+ years of Physician medical coding (ICD-10, CPT, HCPCS II) experience in a multi-specialty physician clinic
2+ years of experience with Evaluation and Management coding plus one or more areas of surgical coding
2+ years of experience being able to provide expert level coding guidance to physicians, practitioners, and coders as needed
Intermediate level of knowledge of MUE and NCCI classification and reimbursement structures
Experience with computers and Windows based programs including MS Excel
Ability to work full-time (40 hours / week), Monday - Friday. Employees are required to have flexibility to work during our normal business hours of 7:00 am - 6:00 pm. Must be flexible to attend client meetings per business needs during our client business hours of Monday - Friday, 7:00 am - 4:30 pm EST. It may be necessary, given the business need, to work occasional overtime
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.
Must be able to communicate effectively face-to-face and in writing
All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

Nice To Haves

Experience auditing charts in a professional coding environment
Experience providing physician/coding education a plus
Experience in Inpatient/Observation E/M coding
Experience with various systems (Microsoft Teams, Encoder Pro, etc.)
Intermediate level of experience with Microsoft Excel

Responsibilities

Serve as a liaison between coding teams and providers, delivering expert guidance to resolve inquiries and concerns
Collaborate with Edits and Denials teams to analyze trends and implement educational initiatives or system edits to address recurring issues
Partner with clinical leadership during the introduction of new services to ensure accurate documentation and coding compliance
Participate in specialty and physician group meetings on a quarterly basis to provide targeted coding education and respond to ad hoc inquiries
Deliver comprehensive coding and documentation training for all newly onboarded providers
Provide annual education to providers on code set updates to maintain compliance and accuracy
Conduct annual provider audits to validate charges and supporting documentation, while identifying potential revenue opportunities
Provide targeted education and follow-up audits for providers who do not meet established quality standards
Perform ad hoc audits in response to client requests or identified concerns
Educate coders and providers on audit findings and emerging trends to promote continuous improvement
Assist coders and/or supervisors as needed on rebuttals for tri-annual audits
Other duties as assigned