Clinical Quality Analyst: OptumInsight

UnitedHealth Group•Eden Prairie, MN

3d•$29 - $52•Remote

About The Position

The Coding Support Subject Matter Expert (SME) serves as a vital resource within their respective health systems, offering expert level guidance and clarification on coding-related questions and issues. This role supports both coders and providers, ensuring accurate and compliant clinical documentation and coding practices across the organization. The SME uses their extensive knowledge of coding systems (e.g. ICD-10, CPT, HCPCS), payer requirements, and industry standards to respond to inquiries promptly and thoroughly. Additionally, the SME proactively identifies trends, knowledge gaps, or recurring issues that signal the need for broader education or systemic improvements. This role plays a key part in promoting coding accuracy, compliance, and optimal revenue integrity. You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges.

Requirements

AHIMA or AAPC coding credentials (e.g., CCS, CPC, RHIT, RHIA)
5+ years of coding experience in a healthcare setting (inpatient, outpatient, or professional coding)
Deep understanding of ICD-10, CPT, HCPCS and official coding guidelines
Solid written and verbal communication skills
Proven ability to research and interpret complex coding guidelines and payer policies
Detail oriented with solid critical thinking and problem-solving skills

Nice To Haves

Experience providing coding support or education
Experience with physician education or clinical documentation improvement (CDI)
Familiarity with X EHR and Y coding tools/systems (adjust based on client)
Knowledge of Medicare and commercial payer reimbursement methodologies

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