Remote Medical Coding Quality Analyst & Appeals Expert

Optum; Newtown Square (Delaware County); On-site; USD 33,000 - 59,000; Full time

Job summary

Optum is seeking a Coding Quality Analyst to review patient records, craft defensible appeal letters, and ensure accurate application of ICD-9/ICD-10, DRG, CM/PCS, CPT, and HCPCS coding. The role involves data extraction, literature-backed arguments, and education of clients on proper coding and compliance.

The position supports telecommuting from anywhere in the U.S. with adherence to established schedules and confidentiality requirements.

Qualifications

• High School Diploma or GED required.
• One of the following coding certifications is required (CCS, CCS-P, CPC-H, CPC, RHIT, RHIA, CDIP, CCDS).
• 3+ years inpatient hospital coding experience.
• 3+ years of DRG methodology experience.
• 3+ years outpatient coding experience.
• 2+ years Medicare/Medicaid experience.
• Strong knowledge of ICD-9-CM and ICD-10 coding.
• Typing speed minimum 45 wpm.

Responsibilities

• Adheres to approved schedule and documents time off per guidelines.
• Compose appeal letters using data extraction and medical literature references.
• Use encoders and coding guidelines (ICD-9/ICD-10, CM/PCS, CPT, HCPCS).
• Engage in tele-hearings as needed; educate clients on coding and compliance.
• Maintain HIPAA confidentiality and professional conduct.
• Collaborate with team and clients to ensure timely deliverables.
• Stay updated with learning modules, competencies, and licenses.

Skills

Inpatient coding experience

DRG methodology

Outpatient coding experience

Medicare/Medicaid experience

ICD-9/ICD-10 knowledge

Typing speed 45 wpm

HIPAA compliance

Verint/HR Direct knowledge

Education

High School Diploma/GED

Coding certifications (CCS, CCS-P, CPC-H, CPC, RHIT, RHIA, CDIP, CCDS)

Associate's or Bachelor's Degree (preferred)

Tools

Microsoft Office Suite

Job description

Optum is seeking a Coding Quality Analyst to review patient records, craft defensible appeal letters, and ensure accurate application of ICD-9/ICD-10, DRG, CM/PCS, CPT, and HCPCS coding. The role involves data extraction, literature-backed arguments, and education of clients on proper coding and compliance.

The position supports telecommuting from anywhere in the U.S. with adherence to established schedules and confidentiality requirements.