Remote Clinical Coding Quality Analyst

University of Minnesota School of Nursing; Plymouth (MN); Remote; USD 33,000 - 59,000; Full time

Job summary

UnitedHealth Group is seeking a Clinical Professional Coding Analyst to support the PPCV product. You will review professional claims and medical records to ensure coding accuracy and compliance, while collaborating with internal and external partners to improve processes and education.

Role offers telecommuting from anywhere in the U.S. and opportunities to contribute to fraud, waste, and error reduction with a focus on maintaining certification and staying current with guidelines.

Qualifications

• High School Diploma/GED required.
• Certified coder CPC, COC, CPMA or CCS or Nursing Licensure.
• 2+ years of healthcare claims auditing, investigation and research.
• 2+ years multi-specialty coding including Evaluation and Management Services.
• 2+ years of experience with Microsoft applications (OneNote, Teams, Excel, Outlook).

Responsibilities

• Perform clinical review of professional claims and supporting medical records to determine whether billed services are supported.
• Maintain departmental productivity, quality, and accuracy standards as established by leadership.
• Develop and communicate clear, concise, and defensible clinical rationales for review determinations.
• Analyze claim, provider, and medical record data to identify discrepancies and reimbursement opportunities.
• Investigate, evaluate, and resolve claim review findings for commercial, government, and health plan customers.
• Ensure compliance with state and federal regulations, reimbursement policies, contractual requirements, and internal guidelines.
• Document review findings and supporting rationale in applicable systems.
• Attend meetings and collaborate with internal stakeholders to promote excellence and continuous improvement.

Skills

Healthcare claims auditing

Coding accuracy

Documentation quality

Education

High School Diploma/GED

CPC

COC

CPMA

CCS

Nursing Licensure

Tools

Microsoft Excel

Microsoft OneNote

Microsoft Teams

Microsoft Outlook

Job description

UnitedHealth Group is seeking a Clinical Professional Coding Analyst to support the PPCV product. You will review professional claims and medical records to ensure coding accuracy and compliance, while collaborating with internal and external partners to improve processes and education.

Role offers telecommuting from anywhere in the U.S. and opportunities to contribute to fraud, waste, and error reduction with a focus on maintaining certification and staying current with guidelines.