Coding Quality Analyst

UnitedHealth Group•Newtown Square, PA

2d•$24 - $43•Remote

About The Position

The Coding Quality Analyst will accurately and efficiently review and extract pertinent case details from patient medical records; and craft strongly defensible appeal letters per process instructions and the department’s/company’s guidance. They will have a working knowledge encoder use and selecting appropriate, supportable appeal arguments from evidence-based, peer reviewed medical literature as provided, as well as interpreting and utilizing ICD 9 and 10, CM and PCS, CPT coding system, and HCPCS guidelines. They will recommend changes to coding which will retain, lessen, or increase financial impact when analysis of chart indicates opportunities. They will educate clients on correct coding and compliance for best practices. They will participate in ALJ (Administrative Law Judge) hearings as representatives of the clients during tele-hearings. The Coding Quality Analyst will complete their case within the time expectations while providing high quality reviews. You will enjoy the flexibility to telecommute from anywhere within the U.S. as you take on some tough challenges.

Requirements

High School Diploma/GED
Possess one of the following coding certifications - CCS, CCS-P, CPC-H, CPC, RHIT, RHIA, CDIP, CCDS
3+ years of Inpatient Hospital Coding experience
3+ years of experience with DRG methodology
3+ years of outpatient coding experience
2+ years of Medicare/Medicaid experience
Mastery level of knowledge of AHA Coding Clinic for ICD-9-CM and ICD-10
Intermediate level of computer proficiency with strong typing skills (minimum of 45 wpm)

Nice To Haves

Associate’s or Bachelor’s Degree
Unrestricted RN license required in state of residence
3+ years of experience in ED, Telemetry, CCU
Auditing experience
Experience with Microsoft applications and software, internet navigation and utilization
Previous experience with presenting before Administrative Law Judge

Responsibilities

Adheres to approved schedule and arrives at work timely
Maintains accurate accounts of time off in both Verint and HR Direct as per guidelines, and follows directives for time off, schedule changes, etc.
Follows directive of composing appeal letters to include appropriate data extraction, construction of well-written appeals letters with proper grammar, utilization of appeal tools including pre-constructed templates, and inclusion of appropriate medical literature references
Use and fluency of encoders, coding clinics, ICD-9 and 10 guidelines, CM and PCS, CPT coding system and HCPCS guidelines
Working knowledge of Word
Effective communication skills
Excellent typing skills with a minimum speed of 45/min
Adheres to company policies and procedures as well as policies, procedures, and laws
Understands and complies with HIPAA confidentiality requirements
Support and promote OPAS, Optum, and the enterprise goals and mission
Build relationships across Optum, OPAS, OGA and our clients
Collaborate with peers to assure continuity of communication and execution of deliverables as needed
Adheres to quality and productivity expectations
Participate in and contribute to meetings as appropriate
Maintains organization on the team and ensures everyone conducts themselves professionally
Remains up to date with all learning modules, competencies, and state required licenses
Performs other related duties, tasks, and processes as required by leadership
Ability to establish priorities, be self-motivated, work independently, and follow instructions with supervision and structure
Positive attitude and the ability to function as a collaborative team member