Coding Quality Analyst

Texas Health Institute; Plymouth, Northern (MN, KY); On-site; USD 60,000 - 80,000; Full time

Job summary

Optum is a global health services company seeking a Coding Quality Analyst to join our team. This full-time role requires 40 hours per week, with flexible 8-hour shifts during CST business hours and potential overtime. You can telecommute from anywhere in the U.S.

while contributing to accurate coding and auditing processes. Primary responsibilities include reviewing records for fraud indicators, documenting decisions, and communicating findings to relevant stakeholders.

Qualifications

• High School Diploma or GED required.
• Active coding certification (AHIMA CCS/CCS-P or RHIT) OR AAPC CPC.
• 2+ years of CPT coding experience.
• 2+ years of medical record auditing experience.
• Full-time availability, 40 hours/week, with standard 8am–5pm CST schedule and potential overtime.

Responsibilities

• Conduct reviews of records identified as suspicious or potentially fraudulent using CPT, ICD-9/ICD-10, HCPCS guidelines.
• Document decisions in company systems with clear notations.
• Discuss and present decisions to internal/external stakeholders as needed.
• Coordinate with team to identify billing trends and coding schemes.

Skills

Attention to detail

Time management

Communication

Education

AHIMA CCS/CCS-P or RHIT

AAPC CPC

Tools

Encoder Pro

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