Coding Quality Analyst

UnitedHealth Group•Plymouth, MN

14h•$24 - $43•Remote

About The Position

The Coding Quality Analyst researches and interprets healthcare coding requirements and guidance, including CMS, CPT/AMA, major payer policies, and internal business rules. The role reviews medical records and documentation, evaluates coding and billing accuracy for facility and physician claims, and prepares written, objective findings. The analyst also provides coding expertise to investigation teams and supports claim management. Approximately 90% of the role is spent on coding and documentation review, with the remaining 10% spent on other assigned tasks. This is a full-time, remote position available to candidates anywhere in the United States. The schedule is Monday through Friday, with flexibility to work an eight-hour shift during normal business hours of 6:00 a.m. to 6:00 p.m. Occasional overtime may be needed. Telecommuters must have a private, dedicated work area, secure sensitive company documents, and access to an approved high-speed internet connection.

Requirements

High school diploma or GED.
At least one of the following coding credentials: RHIA, RHIT, CCS-P, CCS, CPC, or COC.
At least 3 years of medical coding experience, primarily in facility and physician coding.
At least 3 years of experience reviewing, analyzing, and researching coding issues.
Intermediate proficiency with Microsoft Outlook, Excel, and Word, including opening, editing, creating, saving, and sending documents.
Ability to work full-time, Monday through Friday, on an eight-hour shift between 6:00 a.m. and 6:00 p.m., with flexibility for occasional overtime as business needs require.
Ability to pass the Coding Assessment.
For telecommuting: a dedicated work area separated from other living areas that protects information privacy; ability to secure sensitive company documents, if applicable; and residence in a location with UnitedHealth Group-approved high-speed internet or access to an existing high-speed internet service.
Self-starting and independent, with the ability to stay focused while working remotely.
Ability to establish customer relationships based on trust and respect.
High level of attention to written communication.
Telecommuters must adhere to UnitedHealth Group’s Telecommuter Policy.
Candidates must pass a drug test before beginning employment.

Nice To Haves

Associate degree or higher, or equivalent, in Health Information Management.
Experience with reimbursement policy and/or claims.

Responsibilities

Review medical records and supporting documentation against submitted individual provider and facility claims to assess coding and billing accuracy across products.
Process and/or review claims promptly, following client-specific coding and billing requirements and meeting or exceeding production and quality goals.
Participate in process improvement activities and encourage ownership of and group participation in improvement initiatives.
Analyze medical documents to evaluate potential fraud and abuse issues.
Document coding review findings in the investigative case tracking system and maintain thorough, objective documentation.
Serve as a coding resource and provide expertise and guidance to the investigation team.
Identify and recommend opportunities for cost savings and improved outcomes.
Coordinate as needed with leaders, investigative teams, legal counsel, internal and external customers, law enforcement, regulatory agencies, and medical professionals through effective verbal and written communication.
Research and interpret correct coding guidelines and internal business rules to respond to customer inquiries, and monitor CMS and major payer coding and reimbursement policies.

Benefits

Paid time off accrued beginning with the first pay period.
Eight paid holidays.
Medical plan options.
Health Spending Account or Health Savings Account participation.
Dental insurance.
Vision insurance.
Life and AD&D insurance.
Short-term 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, including pet insurance, legal insurance, and long-term care insurance.
Performance rewards and incentive and recognition programs.
Development opportunities.