Coding Quality Analyst

UnitedHealth Group•Walnut Creek, CA

1d•$29 - $52•Remote

About The Position

Explore opportunities with Optum, in strategic partnership with ProHealth Care. ProHealth Care is proud to be a leader in health care services, serving Waukesha County and the surrounding areas for more than a century. Explore opportunities across the full spectrum of care as you help us improve the well-being of the community with your skills, compassion and innovation. Be part of a collaborative environment that strives for excellence, nurtures respect and ensures high-quality care delivery to our patients. Join us in making an impact as an Optum Team Member supporting Pro Health Care and discover the meaning behind Caring. Connecting. Growing together. You will enjoy the flexibility to telecommute from anywhere within the U.S. as you take on some tough challenges. You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear directions on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Requirements

High School Diploma/GED (or higher)
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 coding experience in complex procedures in one or more the following specialty areas: Primary Care, GI, General Surgery, Colorectal, Endovascular, Internal Med, Family Med, Pediatrics, Urgent 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
All Telecommuters 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
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 onboard providers
Provide annual education to providers with on code set updates to maintain compliance and accuracy
Conduct annual provider audits to validate charges and support 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