Coding Quality Analyst - National Remote
Company: Optum
Location: Cedar Hill
Posted on: September 29, 2024
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Job Description:
You'll enjoy the flexibility to telecommute* from anywhere
within the U.S. as you take on some tough challenges.
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 diversity and inclusion, talented peers,
comprehensive benefits, and career development opportunities. Come
make an impact on the communities we serve as you help us advance
health equity on a global scale. Join us to start -Caring.
Connecting. Growing together. - -
An Coding Quality Analyst serves as a resource to others while
performing peer-to-peer overreads on a daily basis. This role will
have assignments of projects where deadlines and scope shift
frequently. Coding Quality Analyst oversees the quality of
main-line coding practices under the direction of their respective
manager.
Positions in this function are responsible for providing expertise
or general support in reviewing, researching, investigating,
negotiating and resolving all types of appeals and grievances.
Communicates with appropriate parties issues, implications and
decisions. Analyzes and identifies trends for appeals and
grievances. The Medical Coder will be responsible for processing
appeals and reviewing billings and medical records to determine the
appropriateness of billings. The Medial Coder will also be involved
in the provision of technical assistance to providers on correct
coding.
This position is full time (40 hours/week) Monday - Friday.
Employees are required to have flexibility to work any of our
8-hour shift schedules during our normal business hours of 8:00am -
5:00pm. It may be necessary, given the business need, to work
occasional overtime.
We offer 4 weeks of on-the-job training. The hours during training
will 8:00am to 5:00pm and then candidate can work flexible shift
after, Monday - Friday. - -
*All Telecommuters will be required to adhere to UnitedHealth
Group's Telecommuter Policy.
Primary Responsibilities:
Reasonable accommodations may be made to enable individuals with
disabilities to perform the essential functions:
Accurately read and analyze CMS as well as client specific coding
guidelines for peer-to-peer and vendor over-reads -
Responsible for reviewing medical records previously coded by peer
to determine and ensure accuracy, completeness, specificity, and
appropriateness of diagnosis codes based on documentation in
accordance with established CMS and client-specific guidelines for
MRA and ACA coding.
Prepares and presents written feedback to coding staff and upper
management
Current working knowledge of ICD-10-CM, CPT, HCPCS coding.
Maintain accurate knowledge of coding compliance and reimbursement
procedures related to top Medicare Risk Adjustment HCC's.
Requires a strong knowledge of diagnostic coding and HCC
documentation requirements.
Semi-flexible schedule with requirement of 40-hour work week.
Support and participate in process and quality improvement
initiatives, implementation/execution. You are good at organizing
and managing multiple priorities and or projects by using
appropriate methodologies and tools.
Problem solving, you are a problem solver with the ability to
encourage others in collaborative problem solving.
Methodical and detail-oriented.
Requires strong ability to work independently with minimum
supervision, excellent reliability, positive attitude, and
demonstrated ability to work timely and effectively under strict
deadlines.
Requires an individual to maintain the ability to work in an
environment with PHI / PII data.
May be assigned other duties.
Must maintain compliance with all company policies and
procedures.
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
Must be 18 years of age OR older
3+ years with Risk Adjustment coding and auditing experience.
Certification from either AAPC and/or AHIMA (CPC, CCS, CRC or
CPMA)
Knowledge of coding industry standards and practices
Experience with Microsoft Word (create correspondence and work
within templates), Microsoft Excel (data entry, sort / filter, and
work within tables) and Microsoft Outlook (email and calendar
management)
Computer proficiency with direct messaging applications (Microsoft
Teams, Webex, etc.)
Ability to train for the first 4 weeks between Monday - Friday,
08:00AM -05:00PM and then candidate can work flexible shift
after.
Ability to work full-time, Monday - Friday between 8:00am - 5:00pm
including the flexibility to work occasional overtime given the
business need
Preferred Qualifications:
Experience with peer-to-peer reviews
Telecommuting Requirements: -
Soft Skills:
California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New
York, Washington, Rhode Island, OR Washington, D.C. Residents Only:
The hourly range for this is $23.22 - $45.43 per hour. Pay is based
on several factors including but not limited to---local labor
markets, education, work experience, certifications,
etc.---UnitedHealth Group complies with all minimum wage laws as
applicable. In addition to your salary, UnitedHealth Group offers
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 UnitedHealth Group, you'll
find a far-reaching choice of benefits and incentives.
-Application Deadline:---This will be posted for a minimum of 2
business days or until a sufficient candidate pool has been
collected. Job posting may come down early due to volume of
applicants.
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.
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Diversity creates a healthier atmosphere: UnitedHealth Group is an
Equal Employment Opportunity / Affirmative Action employer, and all
qualified applicants will receive consideration for employment
without regard to race, color, religion, sex, age, national origin,
protected veteran status, disability status, sexual orientation,
gender identity or expression, marital status, genetic information,
or any other characteristic protected by law.
UnitedHealth Group is a drug - free workplace. Candidates are
required to pass a drug test before beginning employment.
#RPO #RED #RPOLinkedIn
Keywords: Optum, Cedar Hill , Coding Quality Analyst - National Remote, Professions , Cedar Hill, Texas
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