Coding Quality Analyst

UnitedHealth Group Inc. • Plymouth, MN

33d • $23 - $42 • 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. This position is full-time (40 hours/week) Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00am - 4:30pm CST. It may be necessary, given the business need, to work occasional overtime. We offer 2 weeks of on-the-job training. The hours of the training will be aligned with your schedule. 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)
• Certified coder AHIMA (CCS, CCS-P) or AAPC certified coder (CPC, CPC-I) or Nurse (RN, LPN) with unrestricted license
• 2+ years of experience as an AHIMA or AAPC certified coder
• 2+ years of CPT/HCPCS/ICD - 10/CM/PCS coding experience or Licensed nurse with medical record auditing and coding/billing experience
• 1+ years of experience working in a team atmosphere in a metric driven environment including daily production standards and quality standards
• 1+ years of experience with CPT/HCPCS/Modifiers (Medical necessity, DRG, and risk adjustment coding review experience is not applicable to this position)
• 1+ years of experience working with reviewing medical records
• Intermediate level of proficiency with Microsoft & Adobe applications (Outlook, Power Point, Word, Excel, OneNote, Teams, PDF)
• Ability to work full-time, 8:00am - 4:30pm CST including the flexibility to work occasional overtime given the business need
• Must be 18 years of age OR older

Nice To Haves

• Healthcare claims experience/processing experience
• Understanding of Waste & Error principles
• Knowledge of health insurance business, industry terminology, and regulatory guidelines
• Experience with Payment Integrity
• Analytical mindset working with medical terminology or coding

Responsibilities

• Performs clinical review of CPT, HCPCS, and modifiers assigned to codes on claims in a telecommuting work environment
• Determines accuracy of medical coding/billing and payment recommendation for claims
• This could include Medical Director/physician consultations, interpretation of state and federal mandates, applicable benefit language, medical and reimbursement policies and consideration of relevant clinical information
• Determines appropriate level of service utilizing Evaluation and Management coding principles
• Provides detailed clinical narratives on case outcomes
• Perform claim recoding
• Ensures adherence to state and federal compliance policies, reimbursement policies and contract compliance
• Identifies aberrant billing patterns and trends, evidence of fraud, waste, or abuse, and recommends providers to be flagged for review
• Maintains and manages daily case review assignments, with accountability to quality, utilization, and productivity standards
• Provides clinical support and expertise to the other investigative and analytical areas
• Participate in team and department meetings
• Engages in a collaborative work environment when applicable but is also able to work independently
• Serves as a clinical resource to other areas within the clinical investigative team
• Work with applicable business partners to obtain additional information relevant to the clinical review

Benefits

• In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements).
• No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Industry: Insurance Carriers and Related Activities
• Education Level: High school or GED
• Number of Employees: 5,001-10,000 employees