Coding Quality Analyst - Inpatient DRG SME - Remote

Optum; Cleveland (OH); Remote; USD 71,000 - 141,000; Full time

Job summary

An established industry player is seeking a Coding Subject Matter Expert to oversee coding services and operations. This remote role offers the opportunity to drive quality improvements, standardize processes, and enhance client experiences. You will collaborate with various teams to ensure compliance and operational excellence while fostering a culture of teamwork and professional development. With a competitive salary range and comprehensive benefits, this position is perfect for someone looking to make a significant impact in the healthcare sector.

Benefits

Comprehensive Benefits Package

Incentive Programs

Retirement Plans

Qualifications

• Expert knowledge of coding standards and practices.
• Experience in inpatient DRG coding review and quality leadership.

Responsibilities

• Oversee coding services and operations, ensuring quality metrics.
• Lead quality assurance activities and maintain client relationships.

Skills

Inpatient DRG Coding Review

Coding Standards

Client Relationship Management

Quality Assurance

Data Utilization

Education

Active Coding Credential (AAPC or AHIMA)

5+ Years Experience in Coding

Tools

Microsoft Excel

Microsoft PowerPoint

Computer-Assisted Coding

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 diversity and inclusion, talented peers, comprehensive benefits, and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

Role Overview

The Coding SME is responsible for overseeing Optum360 coding services and operations within the assigned region. This includes leading initiatives related to quality metrics, workflow improvements, and audits to ensure best practices and performance excellence. The role involves client-facing meetings, quality improvements, and maintaining strong client relationships, representing Optum360 values.

Primary Responsibilities

1. Maintain expert knowledge of coding standards and practices, driving integration within client environments.
2. Standardize processes, utilize best practices, and improve efficiency and client experience.
3. Collaborate with HIM, CDI, and other teams to monitor daily coding operations and quality reviews.
4. Lead quality assurance activities, including audits and corrective actions.
5. Serve as a liaison to foster cohesive relationships with clients.
6. Utilize tools and data to improve engagement and satisfaction.
7. Lead by example, fostering teamwork and professional development.
8. Participate in leadership forums and lead educational initiatives.
9. Provide team leadership, training, mentoring, and performance recognition.
10. Manage special projects and develop work plans.
11. Ensure compliance with applicable laws, regulations, and organizational standards.

Qualifications

• Current, active coding credential through AAPC or AHIMA.
• 5+ years of experience in inpatient DRG coding review.
• Experience working with CDI and Quality leadership.
• Knowledge of computer-assisted coding and EMR workflows.
• Proficiency in Microsoft Excel and PowerPoint.

Preferred Skills

• Experience with Cloudmed and healthcare regulations.
• Ability to influence change and manage multiple projects.
• Strong interpersonal and leadership skills.

This remote role offers flexibility within the U.S., with a salary range of $71,600 to $140,600 annually, based on experience and other factors. Benefits include comprehensive packages, incentive programs, and retirement plans.