Senior Coding Quality Analyst Remote

UnitedHealth Group • San Antonio, TX

105d • $28 - $50 • Remote

About The Position

The Payment Integrity Coding Consultant position is responsible for determining medical appropriateness of inpatient and outpatient services following evaluation of medical documentation, and published CMS, Coding and other industry criteria. Conducts audits of medical coding to increase coding accuracy and identify potential FWAE. Completes comprehensive examinations of medical records and supporting documents. Provides support related to coding and billing issues to maintain compliance with policies, procedures, laws, and government regulations.

Requirements

• Associate's degree in Healthcare Administration, Business or a related field or HS Diploma/GED with 2+ years of relevant experience above required years of experience may be considered in lieu of Associate's Degree
• Coding certification through AAPC or AHIMA.
• 3+ years of experience in medical claims professional procedure coding and processing
• Experience in reading, interpreting and applying Medicare and CMS Claims and Policies (NCD/LCD/NCCI)
• Solid knowledge of Medicare/CMS claims regulations and policies

Nice To Haves

• 3+ years in a Medical Insurance environment
• Experience working in Payment Integrity, Fraud Waste and Abuse or Special Investigations
• Experience in communicating complicated concepts and information to a wide range of audiences
• Experience working with process improvement teams and streamlining processes as required and improving departmental efficiencies
• Experience with Encoder Pro
• Proven solid analytical and research skills
• Proven excellent written and verbal communication skills

Responsibilities

• Takes ownership of the total work process and provides constructive information to minimize problems and increase customer satisfaction
• FWAE detection and identification of aberrant behavior for providers and facilities
• Investigate, review and provide clinical and/or coding expertise in review of post-service, pre-payment or post-payment claims; which requires interpretation of state and federal mandates, billing practices/patterns, applicable benefit language, medical and reimbursement policies and coding requirements.
• Make pay/deny recommendation decisions based on findings; this could include Medical Director/physician consultations and working independently while making decisions
• Identify updated clinical analytics opportunities and participate in projects as necessary
• Maintain and manage case review assignments
• Ensure issues are identified, tracked, reported and resolved
• Escalate issues as needed for support and/or guidance
• Keep abreast of current Medicare guidelines and regulations by reviewing updates, bulletins and changes to CMS manuals
• Performs all other related duties as assigned

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Industry: Insurance Carriers and Related Activities
• Education Level: Associate degree