Senior Coding Quality Analyst

UnitedHealth Group•Granger, TX

4d•$28 - $50•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. 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. You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges.

Requirements

Associate’s Degree in Healthcare Administration, Business or a related field OR High School 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
3+ years of experience reading, interpreting and applying Medicare and CMS Claims and Policies (NCD/LCD/NCCI)
Live in a location where there is a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service
Proven solid analytical and research skills
Proven excellent written and verbal communication skills
Ability to sit for extended periods of time
Ability to receive and comprehend instructions verbally and/or in writing
Ability to use logical reasoning for simple and complex problem solving

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
Experience with IKA platform

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. Consideration of relevant clinical information on claims with overt billing patterns
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