Clinical Quality Analyst: OptumInsight

UnitedHealth Group; Eden Prairie (MN); Remote; USD 40,000 - 72,000; Full time

Benefits offered by this job

Telecommuter Policy

Comprehensive benefits package

401k contribution

Job summary

UnitedHealth Group's Optum Insight division seeks a Coding Support Subject Matter Expert to guide clinical documentation and coding across health systems. You will respond to inquiries, promote compliance, and collaborate with Edits and Denials teams.

This remote role supports providers and coders nationwide, requires AHIMA/AAPC credentials and 5+ years of experience, and includes annual provider audits, education, and process improvements.

Qualifications

• AHIMA or AAPC credentials (CCS/CPC/RHIT/RHIA) required.
• 5+ years of coding experience in healthcare settings.
• Deep understanding of ICD-10, CPT, HCPCS and coding guidelines.
• Excellent written and verbal communication; attention to detail.

Responsibilities

• Serve as liaison between coding teams and providers, giving expert guidance.
• Collaborate with Edits and Denials to analyze trends and educate.
• Partner with clinical leadership when introducing new services for accurate coding.
• Provide annual provider audits and follow-up education for quality.
• Educate coders/providers on audit findings and emerging trends.

Skills

ICD-10, CPT, HCPCS knowledge

Strong written and verbal comms

Attention to detail

Research and interpret complex coding

Education

AHIMA or AAPC coding credentials (CCS, CPC, RHIT, RHIA)

Tools

X EHR and Y coding tools/systems

Job description

OptumInsightis improving the flow of health data and information to create a more connected system. We remove friction and drive alignment between care providers and payers, andultimately consumers. Our deepexpertisein the industry and innovative technology empower us to help organizations reduce costs while improving risk management,qualityand revenue growth. Ready to help us deliver results that improve lives?Join us to startCaring. Connecting. Growing together.

The Coding Support Subject Matter Expert (SME) serves as a vital resource within their respective health systems, offering expert level guidance and clarification on coding-related questions and issues. This role supports both coders and providers, ensuring accurate and compliant clinical documentation and coding practices across the organization. The SME uses their extensive knowledge of coding systems (e.g. ICD-10, CPT, HCPCS), payer requirements, and industry standards to respond to inquiries promptly and thoroughly.

Additionally, the SME proactively identifies trends, knowledge gaps, or recurring issues that signal the need for broader education or systemic improvements. This role plays a key part in promoting coding accuracy, compliance, and optimal revenue integrity.

You'llenjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

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'llbe 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 asprovidedevelopment for other roles you may be interested in.

Required Qualifications:

• AHIMA or AAPC coding credentials (e.g., CCS, CPC, RHIT, RHIA)
• 5+ years of coding experience in a healthcare setting (inpatient, outpatient, or professional coding)
• Deep understanding of ICD-10, CPT, HCPCS and official coding guidelines
• Solid written and verbal communication skills
• Proven ability to research and interpret complex coding guidelines and payer policies
• Detail oriented with solid critical thinking and problem-solving skills

Preferred Qualifications:

• Experience providing coding support or education
• Experience with physician education or clinical documentation improvement (CDI)
• Familiarity with X EHR and Y coding tools/systems (adjust based on client)
• Knowledge of Medicare and commercial payer reimbursement methodologies

*All employees working remotely will berequiredto 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.

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,locationand 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 marginalizedgroupsand those with lower incomes. We are committed to mitigating our impact on the environment and enabling and deliveringequitablecare 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 adrug -free workplace. Candidatesare required topass a drug test before beginning employment.