Clinical Quality Analyst

UnitedHealth Group•Tampa, FL

5h•Remote

About The Position

Optum Insight is improving the flow of health data and information to create a more connected system. We remove friction and drive alignment between care providers and payers, and ultimately consumers. Our deep expertise in the industry and innovative technology empower us to help organizations reduce costs while improving risk management, quality and revenue growth. Ready to help us deliver results that improve lives? Join us to start Caring. Connecting. Growing together.

Requirements

High School Diploma/GED
Must be 18 years of age OR older
Professional coder certification with credentialing from AHIMA and/or AAPC (CPC, CCS-P, CPMA, CEMC, RHIA, RHIT) to be maintained annually
3+ years of physician (pro-fee) medical coding experience in a multi-specialty physician clinic & surgical service’s
2+ years of experience providing consultation and/or education to physicians and practitioners on coding guidelines and requirements
2+ years of experience with Inpatient and Outpatient E/M coding
Intermediate knowledge of OCE, MUE and NCCI classification and reimbursement structures.
Intermediate proficiency in Microsoft Office Suite
Proficiency with EPIC
Must have experience with ICD-10, CPT, and HCPCS II
Ability to work any 8 hour shift between 7:00 AM and 5:30 PM EST, Monday through Friday.
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.
Ability to communicate effectively face-to-face and in writing
Exceptional communication – both written and verbal
All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy.
Candidates are required to pass a drug test before beginning employment.

Nice To Haves

Experience auditing charts in a professional coding environment
Knowledge of Medicare Ambulatory Payment Classification (APC) codes
Firm understanding of federal coding guidelines
Understanding of appeals/denials process
Knowledge of coding clinics and how to obtain educational information
Expert level experience working in a level I trauma center and/or teaching hospital with a mastery of complex procedures in one or more the following specialty areas: Cardiothoracic, Vascular and Cardiac Catheterizations, Orthopedics, Neurology, Neurosurgery, General Surgery, OB/GYN, Hospitalist, and other specialties may be applicable.

Responsibilities

Assesses and interprets needs of the Ambulatory Coding Team by prioritizing work to meet deadlines.
Review and analyze cloud med inquires
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 Optum
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.