What are the responsibilities and job description for the Clinical Quality Analyst - National Remote position at UnitedHealth Group?

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 (40 hours / week) 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 EST.

We offer 4 weeks of on-the-job training. The hours of the training will be aligned with your schedule.

You’ll enjoy the flexibility to telecommute

from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities :

Assesses and interprets 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.

Apply 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 Optum

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 the 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

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

Professional coder certification with credentialing from AHIMA and / or AAPC & to be maintained annually

Must be 18 years of age OR older

2 years of cardiothoracic and vascular medical coding experience including outpatient & inpatient setting

Must be able to provide expert level coding guidance to coders and coding leadership as needed

Ability to use a PC in a Windows environment, including Microsoft Excel

Ability to work Monday – Friday, 08 : 00AM – 05 : 00PM EST

Preferred Qualifications :

Coding certification with one of the following (CPC, CCS-P, RHIA, RHIT etc.)

Experience with evaluation & management coding

Experience auditing charts in a professional coding environment

Experience providing physician / coding education

Telecommuting Requirements :

Ability to keep all company sensitive documents secure (if applicable)

Required to have a dedicated work area established that is separated from other living areas and provides information privacy

Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service

Soft Skills :

Must be able to communicate effectively face-to-face and in writing

All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

The hourly range for this role is $28.61 to $56.06 per hour based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

Application Deadline : This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location, and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.

Diversity creates a healthier atmosphere : UnitedHealth Group is an Equal Employment Opportunity / Affirmative Action employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

Salary : $29 - $56

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