Coding Quality Analyst

UnitedHealth Group; Bangor (ME); A distancia; USD 40.000 - 72.000; Jornada completa

Descripción de la vacante

UnitedHealth Group is seeking a Coding Quality Analyst to bridge coding teams with providers, ensuring accurate documentation and compliant coding across multi-specialty clinics. You will lead educational initiatives, participate in audits, and guide improvement efforts with clinical leadership.

Requirements include AHIMA/AAPC credentials, 3+ years of physician coding, and proficiency in Epic and MS Excel. This remote role offers telecommuting nationwide with a compensation range based on

Formación

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

Responsabilidades

• Serve as a liaison between coding teams and providers to resolve inquiries.
• Collaborate with Edits and Denials teams to analyze trends and implement educational initiatives.
• Partner with clinical leadership when introducing new services for accurate documentation and coding compliance.
• Deliver comprehensive coding and documentation training for newly onboard providers.
• Conduct annual provider audits to validate charges and support documentation.

Conocimientos

Physician coding

Coding guidance

MS Excel

Epic

AHIMA/AAPC awareness

Educación

High School Diploma/GED

AHIMA/AAPC credential

Herramientas

Encoder Pro

Microsoft Teams

Descripción del empleo

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

Job Description - Coding Quality Analyst (2390164)

Coding Quality Analyst - 2390164

Opportunities at Northern Light Health , in strategic partnership with Optum. Whether you are looking for a role in a clinical setting or supporting those who provide care, we have opportunities for you to make a difference in the lives of those we serve. As a statewide health care system in Maine, we work to personalize and streamline health care for our communities. If the place for you is at a large medical center, a rural community practice or home care, you will find it here. Join our compassionate culture, enjoy meaningful benefits and discover the meaning behind: Caring. Connecting. Growing together.

You will enjoy the flexibility to telecommute* 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 onboard providers
• Provide annual education to providers with on code set updates to maintain compliance and accuracy
• Conduct annual provider audits to validate charges and support 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: Orthopedics, Gastroenterology, General Surgery, Urology, Otorhinolaryngology, Cardiology, Pulmonary Medicine, Womens Health, Podiatry, Neurosurgery, Primary Care, Cardiothoracic, Vascular, Physiatry, Neurology, Ophthalmology, Pain Management, Plastic and Reconstructive Surgery, Wound Care, Radiology, Breast Surgery, Psychiatry, Oral and Maxillofacial Surgery, Oncology, Dermatology, Rheumatology, Optometry
• 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 Telecommuters 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 - $52 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.

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.

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.