UnitedHealth Group

UnitedHealth Group is a healthcare and well-being company that’s dedicated to improving the health outcomes of millions around the world. We are comprised of

Clinical Quality Analyst

Location

United States

Posted

1 day ago

Salary

$29 - $52 / hour

Seniority

Mid Level

No structured requirement data.

Job Description

Clinical Quality Analyst

UnitedHealth Group

Role Description This position is National Remote. You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges. This position is full-time (40 hours / week), Monday - Friday. Employees are required to have flexibility to work during our normal business hours of 7:00 am - 6:00 pm. Must be flexible to attend client meetings per business needs during our client business hours of Monday - Friday, 7:00 am - 4:30 pm EST. It may be necessary, given the business need, to work occasional overtime. We offer weeks of on-the-job training. The hours of the training will be aligned with your schedule. Primary Responsibilities: - Serve as a liaison between coding teams and providers, delivering expert guidance to resolve inquiries and concerns. - Collaborate with Edits and Denials teams to analyze trends and implement educational initiatives or system edits to address recurring issues. - Partner with clinical leadership during the introduction of new services to ensure accurate documentation and coding compliance. - Participate in specialty and physician group meetings on a quarterly basis to provide targeted coding education and respond to ad hoc inquiries. - Deliver comprehensive coding and documentation training for all newly onboarded providers. - Provide annual education to providers on code set updates to maintain compliance and accuracy. - Conduct annual provider audits to validate charges and supporting documentation, while identifying potential revenue opportunities. - Provide targeted education and follow-up audits for providers who do not meet established quality standards. - Perform ad hoc audits in response to client requests or identified concerns. - Educate coders and providers on audit findings and emerging trends to promote continuous improvement. - Assist coders and/or supervisors as needed on rebuttals for tri-annual audits. - Other duties as assigned. Qualifications - High School Diploma / GED. - Professional coder certification with credentialing from AHIMA and/or AAPC (CPC, CCS-P, RHIA, RHIT) to be maintained annually. - Must be 18 years of age OR older. - 3+ years of Physician medical coding (ICD-10, CPT, HCPCS II) experience in a multi-specialty physician clinic. - 2+ years of experience with Evaluation and Management coding plus one or more areas of surgical coding. - 2+ years of experience being able to provide expert level coding guidance to physicians, practitioners, and coders as needed. - Intermediate level of knowledge of MUE and NCCI classification and reimbursement structures. - Experience with computers and Windows based programs including MS Excel. - Ability to work full-time (40 hours / week), Monday - Friday. Employees are required to have flexibility to work during our normal business hours of 7:00 am - 6:00 pm. Must be flexible to attend client meetings per business needs during our client business hours of Monday - Friday, 7:00 am - 4:30 pm EST. It may be necessary, given the business need, to work occasional overtime. Preferred Qualifications - Experience auditing charts in a professional coding environment. - Experience providing physician/coding education a plus. - Experience in Inpatient/Observation E/M coding. - Experience with various systems (Microsoft Teams, Encoder Pro, etc.). - Intermediate level of experience with Microsoft Excel. Telecommuting 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 - Must be able to communicate effectively face-to-face and in writing. Pay and Benefits Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as: - A comprehensive benefits package. - Incentive and recognition programs. - Equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The hourly pay for this role will range from $29.00 to $52.00 per hour based on full-time employment. We comply with all minimum wage laws as applicable. 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.

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