Coding Quality Analyst - National Remote

Optum; Dallas (TX); Remote; Full time

Job summary

Optum is seeking a Coding Quality Analyst for a remote position to handle coding and auditing focused on preventing fraud and waste in healthcare. This role requires a High School Diploma, certification in medical coding, and 2+ years of relevant experience. Ideal candidates will have strong communication skills and organizational abilities, conducting reviews and documenting findings to enhance healthcare outcomes.

Benefits

Comprehensive benefits package

Incentive and recognition programs

401k contribution

Qualifications

• 2+ years of coding experience in CPT medical coding.
• 2+ years of medical record auditing experience.

Responsibilities

• Conduct reviews on suspicious records for potential fraud.
• Document decisions and maintain accurate notations.
• Coordinate with team members to identify billing trends.

Skills

Oral communication

Written communication

Organizational skills

Time management

Education

High School Diploma/GED

Certified Coder AHIMA (CCS, CCS-P or RHIT) or AAPC Certified coder (CPC)

Job description

Coding Quality Analyst - National Remote

Join to apply for the Coding Quality Analyst - National Remote role at Optum

Coding Quality Analyst - National Remote

1 day ago Be among the first 25 applicants

Join to apply for the Coding Quality Analyst - National Remote role at Optum

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 is responsible for coding and auditing services specific to administrative fraud, waste, and abuse cases. This includes the analysis, documentation, explanation and translation of medical and behavioral diagnosis and procedures. The Medical Coder/Analyst will support the PNI in research, issues and inquires that relate to their reviews and policies on Medical Coding/Auditing.

This position is full-time (40 hours/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. 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 on 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
• Certified Coder AHIMA (CCS, CCS-P or RHIT) or AAPC Certified coder (CPC)
• Must be 18 years of age OR older
• 2+ years of coding experience in CPT medical coding
• 2+ years of medical record auditing experience
• Ability to work full-time (40 hours/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. It may be necessary, given the business need, to work occasional overtime
  
  

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

• Oral and written communication skills
• 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 employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy
  
  

The hourly range for this role is $23.70 to $46.35 per hour based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

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

Seniority level

• Seniority level

  Entry level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Quality Assurance

• Industries

  Hospitals and Health Care

Referrals increase your chances of interviewing at Optum by 2x

Sign in to set job alerts for “Quality Analyst” roles.

Sr Quality Engineer w TestCafe & Selenium Grid (Remote)

Plano, TX $77,040.00-$160,500.00 2 days ago

Education & Quality Coding Analyst- Remote Days

Sr Quality Engineer w TestCafe & Selenium Grid (Remote)

Plano, TX $77,040.00-$160,500.00 2 days ago

Business Analyst with Policy Center- 100% Remote

Business analyst withSalesforce HealthCloud

Dallas, TX $41,400.00-$59,100.00 20 hours ago

Springs Window Fashions Business Data Analyst

Sr Business Analyst – Salesforce, Kantata SX & Professional Services Operations - Remote

Senior Business Tax Analyst - Work From Home

We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.