Coding Quality Analyst - National Remote
You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges. 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. The Coding Quality Analyst is required to determine the accuracy of claims submitted by a provider to UnitedHealth Group by comparing it to the medical record(s) submitted for the date(s) of service being reviewed. They must be able to exercise judgement/decision making on complex payment decisions that directly impacts the provider and UHC/Client by following state and government compliance guidelines, coding requirements and policies. They must confidently analyze and interpret data and medical records/documentation on a daily basis to understand historical claims activity, determine validity and demonstrate their ability to provide written communication to the provider. They are responsible to investigate, review and provide clinical and/or coding expertise in a review of pre-payment claims. They need to effectively manage their caseload and monthly metrics in a production driven environment and ensure they are meeting all compliance turnaround times mandated by the client. The Coding Quality Analyst must be proficient in computer skills and able to navigate multiple systems at one time with varying levels of complexity. They must have the ability to research and work independently on making decisions on complex cases. This position is full-time, 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 - 5:00pm. It may be necessary, given the business need, to work occasional overtime. We offer 4 weeks of on-the-job training. The hours during training will be 8:00am - 5:00pm, Monday - Friday. All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy. Primary Responsibilities: Performs quality audits of clinical review cases 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 pre-payment 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. 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. Participates 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. You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications: High school diploma / GED Certified Coder AHIMA or AAPC Certified coder (CPC, CCS, CCS-P) 2 years of experience in medical record auditing and coding/billing 2 years of experience as an AHIMA or AAPC Certified coder 2 years of CPT/HCPCS/ICD - 10/CM/PCS coding experience Knowledge of health insurance business, industry terminology, and regulatory guidelines. 1 year of working in a team atmosphere in a metric driven environment including daily production standards and quality standards. Experience with Microsoft Word (create correspondence and work within templates), Microsoft Excel (data entry, sort / filter, and work within tables) and Microsoft Outlook (email and calendar management) Must be 18 years of age OR older Ability to work any of our 8-hour shift schedules during our normal business hours of 8:00am - 5:00pm. It may be necessary, given the business need, to work occasional overtim
