Coding Quality Analyst SME

Texas Health Institute; Eden Prairie (MN); On-site; USD 39,950 - 71,635; Full time

Benefits offered by this job

Comprehensive benefits package

Incentive and recognition programs

401k contribution

Job summary

Optum is a global health care technology and services company. The Coding Quality Analyst SME role centers on accurate coding reviews, compliance, and education, with daily reconciliations and audit management in collaboration with coding and clinical teams.

You will perform prebill reviews, drive coding quality audits, and support coder education while maintaining client-specific standards. This role offers growth, learning opportunities, and exposure to quality initiatives within UnitedHealth

Qualifications

• High School Diploma or GED required.
• AHIMA or AAPC coding credential maintained annually.
• 4+ years in revenue cycle coding/HIM operations.
• 2+ years acute outpatient coding experience.
• Experience with Microsoft Office.

Responsibilities

• Perform prebill reviews and resolve coding disputes.
• Conduct coding quality audits and provide coder education.
• Maintain client coding guidelines and participate in meetings.
• Support escalation handling and education for coders.

Skills

Coding quality reviews

Microsoft Office

Education

High School Diploma/GED

AHIMA/AAPC credential (CPC/CCS-P/RHIA/RHIT)

Tools

EPIC

Meditech

3M Solventum

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.

Primary Responsibilities:

The role of a Coding Quality Analyst SME centers on ensuring accurate and timely coding reviews with a focus on compliance and education. This position involves daily account reconciliations, audit management, and collaboration with coding and clinical teams.

• Key duties include prebill reviews and resolving coding disputes
• Responsibilities also cover coding quality audits, providing coder education, and maintaining client coding guidelines annually
• The SME supports various meetings, assists in agenda preparation, and provides coverage for other SMEs as needed

Overall, the SME is responsible for keeping coding quality workflows moving, resolving escalations quickly, supporting coders with education and guidance, maintaining client-specific standards, and participating in recurring quality-related meetings.

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
• Professional coder certification with credentialing from AHIMA and/or AAPC (CPC, CCS-P, RHIA, RHIT) to be maintained annually
• 4+ years of experience in revenue cycle operations, specifically Coding and HIM (health information management) support
• 2+ years Acute outpatient coding experience
• Experience with Microsoft Office products

Preferred Qualifications:

• Working knowledge of all areas of the revenue cycle. Detailed knowledge of HIM, Coding, including physician query processes, clinical chart reviews, deficiency analysis, scanning, coding, medical record correction processes, denials, and regulations governing HIM core functions
• Proven exposure to EPIC, Meditech and 3M Solventum ideal
• Proven solid organizational skills, working effectively in a multi-task-based environment, and with an ability to work both independently and collaboratively
• Proven solid leadership, communication, problem-solving, and decision-making skills

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 $29.00 - $52.00 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

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.