CODING QUALITY ANALYST - NATIONAL REMOTE
Company: Optum
Location: San Antonio
Posted on: October 1, 2024
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 older3+ 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
practicesExperience 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 needPreferred
Qualifications:
- Experience with peer-to-peer
reviewsTelecommuting Requirements: -
- Ability to keep all company sensitive documents secure (if
applicable) -
- Required to have a dedicated work area established that is
separated from other living areas and provides information privacy.
-
- Must live in a location that can receive a UnitedHealth Group
approved high-speed internet connection or leverage an existing
high-speed internet service. -Soft Skills:
- Excellent Verbal and written communication skills, including
ability to effectively communicate with internal and external
customers.
- Ability and skill to maintain strong relationships with
multiple stakeholders
- Ability to communicate with different professional levels
- Must be able to work under pressure and meet deadlines, while
maintaining a positive attitude and providing exemplary customer
service.
- Ability to work independently and carry out assignments to
completion within parameters of instructions given, prescribed
routines, and standard accepted practices.
- High level of ethics, integrity, discretion, and
confidentiality.
- Knowledge of customer specifications. 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. -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, San Antonio , CODING QUALITY ANALYST - NATIONAL REMOTE, Professions , San Antonio, Texas
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