Coding Quality Analyst - National Remote

UnitedHealth Group; Plymouth (MN); Remote; Confidential; Full time

Job summary

Join a forward-thinking organization where your expertise in clinical coding will make a significant impact on healthcare outcomes. As a Clinical Coding Analyst, you will engage in detailed coding reviews and documentation assessments, ensuring compliance with regulatory standards. This role offers the flexibility to telecommute while working collaboratively with a diverse team dedicated to advancing health equity. Enjoy a comprehensive benefits package, including paid time off, medical plans, and education reimbursement, all designed to support your career growth and well-being. Be part of a culture that values diversity and inclusion, and help us connect people with the care they need.

Benefits

Paid Time Off

Medical Plan Options

Dental Insurance

401(k) Savings Plan

Education Reimbursement

Employee Discounts

Employee Assistance Program

Employee Referral Bonus Program

Voluntary Benefits

Qualifications

• Strong understanding of coding principles and guidelines.
• Ability to analyze medical documents for accuracy and compliance.

Responsibilities

• Conduct coding reviews and ensure billing accuracy for claims.
• Document findings and provide coding expertise to the investigation team.
• Research coding guidelines and respond to inquiries.

Skills

Clinical Coding

Medical Record Review

Regulatory Compliance

Analytical Skills

Communication Skills

Education

Bachelor's Degree in Healthcare or related field

Coding Certification (CPC, CCS, etc.)

Tools

Investigative Case Tracking System

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.

The Clinical Coding Analyst researches and interprets healthcare correct coding using regulatory requirements and guidance related to CMS, CPT/AMA and other major payer policies. They also use internal business rules to prepare written documentation of findings through medical record review. The Coding Analyst possesses an overall understanding of all coding principles, including facility and physician coding and provides health care payers with a total claim management solution. Typically, 90% of a Coding Analyst’s time is spent performing coding and documentation review and 10% spent performing other tasks as assigned.

This position is full-time, Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 6:00am – 6:00pm. It may be necessary, given the business need, to work occasional overtime.

You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Conduct coding reviews of medical records and supporting documentation against submitted claims, for individual provider and facility claims, to determine coding and billing accuracy for all products.
• Process and/or review claims in a timely manner utilizing client specific coding and billing requirements that meet or exceed production and quality goals.
• Participate in process improvement activities and encourage ownership of and group participation in improvement initiatives.
• Analyze medical documents to evaluate potential issues of fraud and abuse.
• Document coding review findings within investigative case tracking system and maintain thorough and objective documentation of findings.
• Serve as a coding resource and provide coding expertise and guidance to the entire investigation team.
• Identify and recommend opportunities for cost savings and improving outcomes.
• Coordinate activities with varying levels of leadership including the investigative team, legal counsel, internal and external customers, law enforcement and regulatory agencies, and medical professionals through effective verbal and written communications as needed.
• Research and interpret correct coding guidelines and internal business rules to respond to customer inquiries, and monitor CMS and major payer coding and reimbursement policies.
• Must be able to take and pass Coding Assessment.

What are the reasons to consider working for UnitedHealth Group? Put it all together - competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include:

• Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays.
• Medical Plan options along with participation in a Health Spending Account or a Health Saving account.
• Dental, Vision, Life & AD&D Insurance along with Short-term disability and Long-Term Disability coverage.
• 401(k) Savings Plan, Employee Stock Purchase Plan.
• Education Reimbursement.
• Employee Discounts.
• Employee Assistance Program.
• Employee Referral Bonus Program.
• Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.).
• More information can be downloaded at:http://uhg.hr/uhgbenefits.

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