Coding Quality Analyst SME

Colorado Psychiatric; Eden Prairie, Northern (MN, KY); Hybrid; USD 40,000 - 72,000; Full time

Job summary

UnitedHealth Group is seeking a Coding Quality Analyst SME in Minnesota to ensure accurate coding reviews, conduct audits, and educate coders. The role involves daily reconciliations, guideline maintenance, and collaboration with coding and clinical teams.

Qualifications include a high school diploma or GED, AHIMA/AAPC certification, and 4+ years in revenue cycle operations with 2+ years in acute outpatient coding.

Qualifications

• High School Diploma or GED required.
• Professional coder certification (AHIMA and/or AAPC) renewed annually.
• 4+ years in revenue cycle operations, coding and HIM support.
• 2+ years Acute outpatient coding experience.
• Experience with Microsoft Office products.

Responsibilities

• Perform prebill reviews and resolve coding disputes.
• Conduct coding quality audits and coder education.
• Maintain client coding guidelines on an annual basis.
• Support meetings, assist in agenda prep, and cover other SMEs as needed.
• Keep coding quality workflows moving and resolve escalations.

Skills

Revenue cycle

HIM coding

Coder education

Audits

Education

High School Diploma or GED

AHIMA/AAPC certification (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.