Clinical Quality Analyst: OptumInsight

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

Benefits offered by this job

Telecommuter Policy

Job summary

UnitedHealth Group is seeking a Clinical Quality Analyst: OptumInsight SME to provide expert coding guidance, education, and support across health systems. This role analyzes trends, educates providers, and ensures accurate documentation and compliance with ICD-10, CPT, and HCPCS guidelines.

You’ll work remotely from anywhere in the U.S. and collaborate with Edits and Denials teams, leadership, and auditors to improve revenue integrity and quality.

Qualifications

• AHIMA or AAPC credentials (e.g., CCS, CPC, RHIT, RHIA) required.
• Minimum 5 years of coding experience in healthcare settings.
• Deep understanding of ICD-10, CPT, HCPCS and official coding guidelines.
• Strong written and verbal communication skills.
• Ability to research and interpret complex coding guidelines and payer policies.
• Detail oriented with solid critical thinking and problem-solving abilities.

Responsibilities

• Serve as a liaison between coding teams and providers, delivering expert guidance.
• Collaborate with Edits and Denials to analyze trends and implement education.
• Partner with clinical leadership to ensure accurate documentation and coding compliance.
• Participate in quarterly meetings to provide coding education and respond to inquiries.
• Deliver comprehensive coding and documentation training for new providers.
• Provide annual education on code set updates to maintain compliance.
• Conduct annual provider audits to validate charges and identify revenue opportunities.
• Provide audits and follow-up for providers not meeting quality standards.
• Perform ad hoc audits in response to client requests.
• Educate coders and providers on audit findings and emerging trends.
• Assist with rebuttals for tri-annual audits as needed.

Skills

AHIMA/AAPC credentials

5+ years coding experience

ICD-10 CPT HCPCS knowledge

Communication skills

Research & interpretation

Attention to detail

Tools

X EHR

Y coding tools

Job description

Improve the lives of others while Caring. Connecting. Growing together.

Job Description - Clinical Quality Analyst: OptumInsight (2386170)

Clinical Quality Analyst: OptumInsight - 2386170

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 a drug –free workplace. Candidates are required to pass a drug test before beginning employment.

UnitedHealth Group is committed to working with and providing reasonable accommodations to individuals with physical and mental disabilities. If you need special assistance or accommodation for any part of the application process, please call 1-866-566-8715 to be connected to Recruitment Services. Recruitment Services hours of operation are 7 a.m. to 7 p.m. CT, Monday through Friday.

UnitedHealth Group is a registered service mark of UnitedHealth Group, Inc. The UnitedHealth Group name with the dimensional logo, as well as the dimensional logo alone, are both service marks for the UnitedHealth Group, Inc.

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.