Coding Compliance Analyst

UnitedHealth Group • Worcester, MA

3d • $24 - $43 • 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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.
As a Coding Compliance Analyst, you will be responsible for procedure and diagnostic coding of professional charges. Works closely with clinical department physicians and staff to ensure accurate and compliant coding and maximization of revenue through initial coding.

Requirements

• High School Diploma/GED (or higher)
• Certified Professional Coder (CPC, CCS-P, CEMC, CPMA or COC)
• 1+ years of experience utilizing standard scoring (CMS) methodologies to report findings to providers
• 1+ years of experience employing clinical references with the auditing process
• 1+ years of experience with Apply CPT and ICD-10 coding convention to documentation guidelines
• 1+ years of experience with Apply CMS and other payer constraints to final code and documentation determination
• 1+ years of demonstrated experience in a physician/professional billing environment
• 1+ years of demonstrated experience with third party payer guidelines
• Ability to obtain CPMA within 1 year of employment

Nice To Haves

• Experience with ICD-10, CPT and HCPCS coding
• Experience with auditing physician medical records utilizing E+M guidelines
• Experience with Microsoft Office Suite (Excel, Word, Power Point) or successful completion of related courses. Must show proficiency in current billing software within six (6) months
• Demonstrated experience in the application of medical terminology, anatomy and physiology or successful completion of related college courses

Responsibilities

• Participates in the identification and resolution of areas requiring additional intervention through established Coding/Billing and Corporate Compliance work plans
• Develops and implement clinic-wide training programs geared towards educating clinical and non-clinical support staff regarding compliance related topics and/or deficiencies identified through documentation/coding and billing compliance audits
• Develops and delivers clinic-wide memorandums/educational materials pertaining to relevant revenue integrity initiatives
• Identifies trends that result in lost revenue and educates provider as appropriate
• Assist in the review and update of annual Revenue Integrity & Education work plan and audit schedule
• Performs formal review of annual CPT/Diagnosis/HCPCS changes and prepares educational documents by specialty highlighting significant changes
• Trains providers, staff, and others in small and large group sessions
• Meet deadlines, productivity targets as defined in the Coding/Billing Compliance work Plan
• Communicates effectively at all levels in the organization, including clinical and non-clinical support staff, managers, physicians, and medical leadership
• Conducts random and scheduled internal audits of physician billing and medical records documentation to ensure: Correct Coding (CPT, ICD-10, HCPCS, Modifiers), Accurate Data Entry, Accurate Charge Preparation/Processing, Compliance with governmental and third-party billing regulations
• Conducts quarterly audits of Coding staff to ensure correct coding and to identify training opportunities
• Utilizes Microsoft Excel / Word, to document and report audit results to the appropriate personnel, including physicians/providers and Medical Leadership
• Works collaboratively with clinical department physicians, mid-level providers, and other staff to ensure appropriate and compliant documentation, coding, and billing practices
• Develops and tracks progress of internal audit schedules
• Serves as an internal compliance resource for Patient Accounts, Clinical departments, and for coding and documentation questions
• Utilizes the Internet, intranet, internal reference library, available workshops and/or seminars and other sources to stay current with government and local third-party payer coding, specialty specific and reimbursement rules, and requirements
• Measures and reports coding trends as compared to national standards; or claim/documentation reviews. Documents and reports result to all appropriate parties
• Monitors and productivity reports and other data as requested by manager
• Participate in all governmental and third-party insurance audits
• Assist in developing Revenue Integrity and Education Policies and Procedures
• Comply with all established departmental policies, procedures, and objectives
• Maintains all Professional certifications
• Attends a variety of meetings as required or directed
• Performs other similar and related duties as required or directed
• Must be able to work as a team and independently as needed
• Regular, reliable, and predicable attendance is required

Benefits

• Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays
• Medical Plan options along with participation in a Health Spending Account or a Health Saving account
• Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage
• 401(k) Savings Plan, Employee Stock Purchase Plan
• Education Reimbursement
• Employee Discounts
• Employee Assistance Program
• Employee Referral Bonus Program
• Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED