Clinical Quality Analyst

UnitedHealth Group•Bangor, ME

8d•$29 - $52•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.

Requirements

High School Diploma/GED
Professional coder certification with credentialing from AHIMA and/or AAPC (CPC, CCS-P, RHIA, RHIT) to be maintained annually
3+ years of Physician medical coding (ICD-10, CPT, HCPCS II) experience in a multi-specialty physician clinic
2+ years of experience with Residency Program (teaching hospital) with surgical coding experience in Evaluation and Management plus one or more of the following: Neurology + one or more of the following, Breast Surgery, Dermatology, Endocrinology, Gastroenterology, Oncology, Opthalmology, Optometry, Oral Surgery, Otorhinolaryngology, Pain Management, Physiatry, Podiatry, Pulmonary Medicine, Rheumatology, Sleep Medicine, Urology, Vascular Care, Wound Care
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
Intermediate level of proficiency in a Windows PC environment, including MS Excel and with Epic
Must be able to communicate effectively face-to-face and in writing

Nice To Haves

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