Coding Quality Analyst Remote
About The Position
Optum Insight is seeking a Coding Quality Analyst to conduct regulatory compliance audits and support coding quality across Optum Middle Revenue Cycle. The role monitors changes to laws and regulations, helps establish and implement standard policies and procedures, and supports best practices. It includes client-facing work with Quality Teams, CDI, and other groups associated with accounts and prebill reviews, including HACs and PSIs. The analyst maintains client relationships and represents Optum360’s values. The position conducts internal inpatient coding audits, analyzes results and trends to identify risks and process gaps, and communicates findings to stakeholders. It provides quality feedback to coding staff and leadership, supports quality reporting and coder education, and serves as a subject matter expert on coding practices and applicable laws, regulations, and organizational policies. The analyst also collaborates with regulators and internal and external stakeholders, helps identify root causes and mitigate compliance risks, and develops or contributes to compliance training. This role is remote and may be performed from anywhere within the United States, subject to UnitedHealth Group’s Telecommuter Policy. The stated annual salary range is $60,200–$107,400 for full-time employment. Benefits are subject to eligibility requirements.
Requirements
- High school diploma or GED.
- AAPC or AHIMA certification: CCS, CPC, RHIT, or RHIA.
- At least 3 years of inpatient facility coding and auditing experience.
- At least 1 year of experience working collaboratively with CDI and quality leadership to improve reimbursement and coding accuracy.
- At least 1 year of experience with computer-assisted coding technologies and EMR coding workflows.
- Intermediate proficiency with Microsoft Excel, Word, PowerPoint, and SharePoint.
- Advanced organizational skills, including the ability to multitask, deliver rapid turnaround, and manage multiple projects effectively.
- Remote employees must adhere to UnitedHealth Group’s Telecommuter Policy.
- Candidates must pass a drug test before beginning employment.
Nice To Haves
- Outpatient coding experience in a coder or reviewer role.
- Operational knowledge of healthcare-related Federal and State regulations and standards from regulatory agencies and accrediting organizations, such as CMS and TJC.
- Demonstrated ability to work with individuals in executive, managerial, and staff roles across corporate/national, regional, and local organizations, and to interact with external parties such as financial auditors, third-party payer auditors, consultants, and hospital associations.
- A personal presence characterized by honesty, integrity, and caring, with the ability to inspire and motivate others in support of Optum360 and client organizations’ philosophy, mission, vision, goals, and values.
Responsibilities
- Conduct internal monitoring and audits of inpatient coding charts to identify process gaps and help address organizational risks.
- Analyze audit and monitoring results to identify potential risks and communicate findings as needed.
- Identify and analyze patterns and trends that may indicate compliance issues, and communicate them as needed.
- Complete internal coding quality audits and provide performance feedback to coding specialists, team leadership, and coding educators.
- Maintain expert knowledge of coding, coding operations, coding reviews, and coding best practices; integrate Optum360 coding business objectives into client environments.
- Apply knowledge of applicable Federal, State, and local laws and regulations, the organizational integrity program, standards of conduct, and other policies and procedures to support compliance and ethical conduct.
- Communicate the potential business, operational, and consumer impacts of compliance issues and risks to relevant stakeholders.
- Collaborate with regulators, including CMS, to prevent or address potential compliance issues.
- Work with internal stakeholders across organizational lines to identify root causes of compliance issues and support risk-mitigation actions.
- Develop and/or deliver training on compliance issues and risks to applicable audiences.
- Consult with internal and external stakeholders, including regulators, legal staff, and vendors, to support effective compliance programs.
- Partner with learning organizations to develop or implement compliance training offerings.
- Consult with business partners on effective approaches to support and enforce compliance.
- Provide input on business training programs to ensure appropriate compliance content is included.
- Assess and respond to external stakeholders’ required compliance training needs, as appropriate.
- Serve as liaison for external quality stakeholders, including compliance, core measures, patient safety, and premier data integrity.
- Support coding leadership with quality data reporting and work with coding educators to identify coder education topics.
- Perform other duties as assigned by Optum360 leadership.
Benefits
- Comprehensive benefits package, subject to eligibility requirements.
- Incentive and recognition programs.
- Equity stock purchase program.
- 401(k) contribution.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
