Coding Quality Analyst

Stryker Corporation; Plymouth (MN); Hybrid; Confidential; Full time

Benefits offered by this job

Remote work

Job summary

UnitedHealth Group is seeking a Coding Quality Analyst to join our remote-friendly team. This full-time role involves reviewing records for potential fraud, coding accuracy, and collaboration with colleagues across departments. Flexible 8-hour shifts within CST hours may be required, with occasional overtime.

Strong attention to detail and communication are essential. You will work from a home office anywhere in the U.S., with structured training and ongoing development opportunities.

Qualifications

• High School Diploma or GED required.
• AHIMA CCS/CCS-P or RHIT, or AAPC CPC certification.
• 2+ years CPT medical coding experience.
• 2+ years medical record auditing experience.
• Full-time 40 hours/week; 8am-5pm CST; possible overtime.
• Must be 18 years or older.

Responsibilities

• Review records identified as suspicious or potentially fraudulent.
• Document decisions in company systems.
• Discuss and present decisions with internal/external groups.
• Coordinate with team to identify billing and coding trends.

Skills

Strong communication

Time management

Independent worker

Education

High School Diploma/GED

Tools

Encoder Pro

CMS 1500 knowledge

UB04 knowledge

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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale.

Join us to start Caring. Connecting. Growing together.

The Coding Quality Analyst position is full time 40hours/week Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8am - 5pm CST. It may be necessary, given the business need, to work occasional overtime.

We offer 4 weeks of on-the-job training. The hours of 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

• Conducts reviews on records that have been identified as suspicious and/or potentially fraudulent, utilizing most current reference materials to include, but not limited to: Current Procedural Terminology (CPT), Internal Classification of Disease (ICD-9/ICD 10) and Healthcare Common Procedure Coding System (HCPCs) guidelines
• Documents Decisions on reviews through notations and enters notes in appropriate company systems
• Ability to discuss and present decisions made to appropriate internal and external individuals/groups
• Coordinate with team members to understand trends and schemes related to billing issues/coding trends

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
• Active and unrestricted coding certification from AHIMA (CCS, CCS-P or RHIT) or AAPC (CPC)
• 2+ years of coding experience in CPT medical coding
• 2+ years of medical record auditing experience
• Ability to work full time 40hours/week Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8am - 5pm CST. It may be necessary, given the business need, to work occasional overtime
• Must be 18 years of age or older

Preferred Qualifications

• Behavioral Health experience
• Experience with fraud, waste, abuse, and error
• Knowledge of CMS 1500 and UB04 data elements
• Encoder Pro familiarity

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

• Strong oral and written communication skills
• Strong organizational/time management skills and be able to work independently or as a team
• Ability to meet production unit standards while engaging in multiple priorities

*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 $24 - $43 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