Unlock a Rewarding Career with Optum, a Global Leader in Health Care
At Optum, a part of UnitedHealth Group, we're driven by a mission to help people live healthier lives and make the health system work better for everyone. Our team is dedicated to delivering care, aided by technology, to millions of people around the world. As a Coding Quality Analyst, you will play a critical role in our efforts to combat administrative fraud, waste, and abuse in the health care system. Join us to make a meaningful impact on the communities we serve and advance health equity on a global scale.
About the Role
We're seeking an experienced Coding Quality Analyst to join our team on a full-time basis, working remotely from anywhere within the United States. As a Coding Quality Analyst, you will be responsible for analyzing, documenting, and explaining medical and behavioral diagnosis and procedures related to administrative fraud, waste, and abuse cases. Your expertise will support our research, issues, and inquiries, ensuring the integrity of our medical coding and auditing processes.
Primary Responsibilities
- Conduct thorough reviews of records identified as suspicious or potentially fraudulent, utilizing current reference materials such as CPT, ICD-9/ICD-10, and HCPCs guidelines.
- Document decisions on reviews through detailed notations and enter notes into our company systems.
- Present and discuss decisions made with internal and external stakeholders, providing clear and concise explanations.
- Collaborate with team members to identify trends and schemes related to billing issues and coding trends.
Essential Qualifications
To succeed in this role, you must possess:
- A High School Diploma or GED.
- A coding certification from AHIMA (CCS, CCS-P, or RHIT) or AAPC (CPC).
- At least 2 years of experience in CPT medical coding.
- A minimum of 2 years of medical record auditing experience.
- The ability to work a standard Monday to Friday schedule, with flexibility to adapt to our 8-hour shift schedules during normal business hours (8am - 5pm).
- Strong oral and written communication skills.
- Excellent organizational and time management skills, with the ability to work independently and as part of a team.
Preferred Qualifications
While not mandatory, the following qualifications are highly desirable:
- Experience working in Behavioral Health.
- Familiarity with fraud, waste, abuse, and error detection.
- Knowledge of CMS 1500 and UB04 data elements.
- Proficiency in Encoder Pro.
Telecommuting Requirements
As a remote worker, you must be able to:
- Maintain the security of company-sensitive documents.
- Establish a dedicated workspace that is separate from living areas and ensures information privacy.
- Have access to a UnitedHealth Group-approved high-speed internet connection.
What We Offer
At Optum, we provide a comprehensive benefits package, including:
- A competitive salary, with an hourly range of $23.22 to $45.43 per hour, depending on location, education, and experience.
- Incentive and recognition programs to reward your performance.
- Equity stock purchase and 401k contribution opportunities.
- 4 weeks of on-the-job training to support your success in the role.
- A culture guided by diversity and inclusion, with opportunities for career development and growth.
Career Growth and Development
At Optum, we're committed to your long-term success. You'll have access to:
- Clear direction on what it takes to succeed in your role and advance in your career.
- Opportunities for professional growth and development.
- A collaborative and supportive work environment that fosters learning and innovation.
Our Culture
We're proud to be an Equal Employment Opportunity / Affirmative Action employer, committed to creating a diverse and inclusive workplace. Our culture is guided by a passion for improving health outcomes and a commitment to making a positive impact on the communities we serve.
Why Join Us?
If you're a motivated and detail-oriented professional looking to make a difference in the health care industry, we want to hear from you. Even if you feel you're not a perfect match, we'd still love to hear from you. We're looking for great people to join our friendly team and contribute to our mission.
Apply now to start your journey with Optum and be part of a team that's dedicated to helping people live healthier lives.
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