Clinical Quality Analyst

NHSHP; Bangor, Northern (ME, KY); Hybrid; USD 40,000 - 72,000; Full time

Benefits offered by this job

Comprehensive benefits

Incentive and recognition programs

Equity stock purchase plan

401k contribution

Job summary

Optum is seeking a physician coding specialist to serve as a liaison between coding teams and providers, ensuring accurate documentation and coding across multiple specialties. The role includes delivering education, audits, and guidance to physicians, coders, and staff.

The ideal candidate has 3+ years of physician coding experience (ICD-10, CPT, HCPCS II) in a teaching hospital setting with surgical E/M coding and strong knowledge of MUE/NCCI.

Qualifications

• High School Diploma or GED required.
• AHIMA and/or AAPC coding certification (CPC, CCS-P, RHIA, RHIT) maintained annually.
• 3+ years of Physician medical coding (ICD-10, CPT, HCPCS II) experience in a multi-specialty physician clinic.
• 2+ years of Residency Program experience with surgical coding in E/M and multiple specialties.
• 2+ years of experience providing expert coding guidance to physicians, practitioners, and coders.
• Intermediate knowledge of MUE and NCCI classification and reimbursement structures.
• Intermediate proficiency in Windows, MS Excel, and Epic.

Responsibilities

• Serve as liaison between coding teams and providers to resolve inquiries and concerns.
• Collaborate with Edits and Denials teams to analyze trends and address recurring issues.
• Partner with clinical leadership during introduction of new services to ensure accurate documentation and coding compliance.
• Participate in quarterly specialty/physician group meetings to provide targeted coding education and respond to inquiries.
• Deliver comprehensive coding and documentation training for all newly onboarded providers.
• Provide annual education to providers on code set updates to maintain compliance and accuracy.
• Conduct annual provider audits to validate charges and supporting documentation and identify revenue opportunities.
• Provide targeted education and follow-up audits for providers who do not meet established quality standards.
• Perform ad hoc audits in response to client requests or identified concerns.
• Educate coders and providers on audit findings and emerging trends to promote continuous improvement.
• Assist coders/supervisors with rebuttals for tri-annual audits.

Skills

Physician medical coding

MUE & NCCI knowledge

MS Excel

Epic

Communication skills

Medical education

Education

High School Diploma or GED

AHIMA/AAPC coding certification (CPC, CCS-P, RHIA, RHIT)

Tools

Epic

Encoder Pro

Microsoft Teams

Job description

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.

Primary Responsibilities

• Serve as a liaison between coding teams and providers, delivering expert guidance to resolve inquiries and concerns
• Collaborate with Edits and Denials teams to analyze trends and implement educational initiatives or system edits to address recurring issues
• Partner with clinical leadership during the introduction of new services to ensure accurate documentation and coding compliance
• Participate in specialty and physician group meetings on a quarterly basis to provide targeted coding education and respond to ad hoc inquiries
• Deliver comprehensive coding and documentation training for all newly onboarded providers
• Provide annual education to providers on code set updates to maintain compliance and accuracy
• Conduct annual provider audits to validate charges and supporting documentation, while identifying potential revenue opportunities.
• Provide targeted education and follow-up audits for providers who do not meet established quality standards.
• Perform ad hoc audits in response to client requests or identified concerns.
• Educate coders and providers on audit findings and emerging trends to promote continuous improvement.
• Assist coders and/or supervisors as needed on rebuttals for tri-annual audits

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear directions 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 (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
• 2+ years of experience with Residency Program (teaching hospital) with surgical coding experience in Evaluation and Management plus one or more of the following: Neurology + one or more of the following, Breast Surgery, Dermatology, Endocrinology, Gastroenterology, Oncology, Opthalmology, Optometry, Oral Surgery, Otorhinolaryngology, Pain Management, Physiatry, Podiatry, Pulmonary Medicine, Rheumatology, Sleep Medicine, Urology, Vascular Care, Wound Care
• 2+ years of experience being able to provide expert level coding guidance to physicians, practitioners, and coders as needed
• Intermediate level of knowledge of MUE and NCCI classification and reimbursement structures
• Intermediate level of proficiency in a Windows PC environment, including MS Excel and with Epic

Preferred Qualifications:

• Experience auditing charts in a professional coding environment
• Experience providing physician/coding education a plus
• Experience with various systems (Microsoft Teams, Encoder Pro, etc.)
• Experience in Inpatient/Observation E/M coding
• Intermediate level of experience with Microsoft Excel

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.

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $29.00 to $52.00 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

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.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

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

#RPO, #GREEN