Remote Coding Quality Analyst – Fraud & Compliance

Texas Health Institute; Plymouth, Northern (MN, KY); Hybrid; USD 60,000 - 80,000; Full time

Job summary

Optum is a global health services company seeking a Coding Quality Analyst to join our team. This full-time role requires 40 hours per week, with flexible 8-hour shifts during CST business hours and potential overtime. You can telecommute from anywhere in the U.S.

while contributing to accurate coding and auditing processes. Primary responsibilities include reviewing records for fraud indicators, documenting decisions, and communicating findings to relevant stakeholders.

Qualifications

• High School Diploma or GED required.
• Active coding certification (AHIMA CCS/CCS-P or RHIT) OR AAPC CPC.
• 2+ years of CPT coding experience.
• 2+ years of medical record auditing experience.
• Full-time availability, 40 hours/week, with standard 8am–5pm CST schedule and potential overtime.

Responsibilities

• Conduct reviews of records identified as suspicious or potentially fraudulent using CPT, ICD-9/ICD-10, HCPCS guidelines.
• Document decisions in company systems with clear notations.
• Discuss and present decisions to internal/external stakeholders as needed.
• Coordinate with team to identify billing trends and coding schemes.

Skills

Attention to detail

Time management

Communication

Education

AHIMA CCS/CCS-P or RHIT

AAPC CPC

Tools

Encoder Pro

Job description

Optum is a global health services company seeking a Coding Quality Analyst to join our team. This full-time role requires 40 hours per week, with flexible 8-hour shifts during CST business hours and potential overtime. You can telecommute from anywhere in the U.S.

while contributing to accurate coding and auditing processes. Primary responsibilities include reviewing records for fraud indicators, documenting decisions, and communicating findings to relevant stakeholders.