Senior Coding Quality Analyst

UnitedHealth Group • Walnut Creek, CA

119d • $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 diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together. This position is full-time, Monday - Friday. Employees are required to work 8-hour shifts between 6 AM and 6 PM. It may be necessary, given the business need, to work occasionally overtime or weekends. You'll enjoy the flexibility to telecommute from anywhere within the U.S. as you take on some tough challenges.

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.
• Expert level of experience working in a level II trauma center and/or teaching hospital with a mastery of complex procedures in one or more the following specialty areas: Cardiothoracic, Vascular and Cardiac, Urology, Oncology, Gastroenterology, General Surgery, OB/GYN, Hospitalist, Primary Care, and other specialties may be applicable.
• Expert level of experience with professional E/M coding.
• Intermediate level of knowledge of OCE, MUE and NCCI classification and reimbursement structures.
• Ability to use a PC in a Windows environment, including MS Excel and various EMR systems.
• Must be able to communicate effectively face-to-face and in writing.
• Must be able to provide expert level coding guidance to physicians, practitioners, and coders as needed.

Nice To Haves

• Experience auditing charts in a professional coding environment.
• Experience providing physician/coding education.
• Experience with various systems (CACp, EPIC, Allscripts, IDX, RCX, Encoder Pro).
• Intermediate level of experience with Microsoft Excel.

Responsibilities

• Assesses and interprets the needs of the Ambulatory Coding Team by prioritizing work to meet deadlines.
• Identifies solutions to non-standard edits, workflows, and issues.
• Solves complex questions and conducts analysis of trends to provide education for the coding staff and clients including physicians/providers.
• Provides detailed education to the Coding Team and acts as a resource to others.
• Train and review assignments completed by new employees and provide post-hire reviews as needed.
• Provide expert coding knowledge to professional coding and billing initiatives and inquiries.
• Identify appropriate assignment of ICD-10-CM, CPT, and HCPCS II Codes for physician services, while adhering to the official coding guidelines and established client coding guidelines of the assigned facility.
• Understand the Medicare Ambulatory Payment Classification (APC) codes.
• Adhere to the ethical standards of coding as established by AAPC and/or AHIMA.
• Adhere to and maintain required levels of performance in both coding quality and productivity as established by Optum360.
• Understand federal coding register and ensure guidelines are used and followed appropriately.
• Understanding of appeal process with knowledge how to speak to denial and/or appeals.
• Provide documentation feedback to providers and query physicians when appropriate.
• Maintain up-to-date Coding knowledge by reviewing materials disseminated/recommended by Compliance, Coding Operations, etc.
• Participate in coding department meetings and educational events.
• Strong knowledge of coding clinics and how to obtain education information.
• Process Rebills as appropriate.
• Other duties at the discretion of the Coding Supervisor.

Benefits

• Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays.
• Medical Plan options along with participation in a Health Spending Account or a Health Saving account.
• Dental, Vision, Life & AD&D Insurance along with Short-term disability 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 (pet insurance, legal insurance, LTC Insurance, etc.).

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Industry: Insurance Carriers and Related Activities
• Education Level: High school or GED