Job was saved successfully.
Job was removed from Saved Jobs.

Job Details

UnitedHealth Group

Senior Coding Quality Analyst - Remote


Quality Assurance Manager


Huntington Beach, California, United States

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. Come make an impact on the communities we serve as we help advance health equity on a global scale. Here, you will find talented peers, comprehensive benefits, a culture guided by diversity and inclusion, career growth opportunities and your life's best work.(sm)

Optum Health provides longitudinal care to our Medicare Advantage Health Plan members within the home, ALF and SNF settings. The coding team applies all ICD-10-CM codes with risk adjustment rules as required. Additionally, all CPT codes are applied however, are not the primary focus for the Landmark Health model of billing utilized.

The Senior Coding Quality Analyst is a Coding Professional who is a senior member of the Coding Operations Team who hold extensive knowledge of Coding/CCR operations, workflows, and Coding guidelines. Coding Operations SMES are skilled collaborators, communicators and problem solvers and are the are the front-line resource to their assigned project teams. The SME will collaborate with Coding Operations Home and Community Coding Managers, Leaders, and the Sr. Coding Educators to meet the needs of our customers with the goal of supporting the Learning and Development needs of assigned project teams. This role will support activities in General Operations/Projects, Education, and Quality/Compliance You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

  • The major focus of the responsibilities of this auditor position is working on and with Health Plans and their requests of an audit monthly, quarterly, or annually to ensure medical documentation and supporting evidence or MEAT complies with the risk adjustment initiatives. Always improving quality of coding and compliance
  • Performing an internal audit review of charts prior to receiving the findings from the health plan to identify any concerns prior to official review
  • Auditing diagnoses data collected from Health Plan audits and performing a systematic critical analysis ensuring all applicable standards are met according to ICD-10-CM Guidelines, AHA Coding Clinics, Internal Coding Guidance, and other approved resources, for the quality of documentation and the accuracy of ICD-10 coding and risk adjustment requirements and determining deficiencies of under or up-coding ICD-10 and HCC codes. Thereby, identifying error or areas for improvement, or where changes or in-service education is needed to the coding team
  • To formulate responses, recommendations and solutions based on audit findings, trends, and results
  • To formulate a final report of findings within both the internal review and post health plan discussion and providing score accuracy numbers for HCC and Non-HCC codes
  • Assuring the accuracy of diagnosis and procedure coding as documented, to ensure accurate reporting of services for appropriate capture and to support corporate compliance
  • Performance requires a high level of attention to detail
  • Communication to the clinical team as needed if error appears clinical vs. coding related
  • Assist QA Manager or personally present findings on meetings with health plan as a discussion of disputed items
  • Notifying coders as corrections that may need to be made and ensuring they are completed
  • Identifying new standards or policy changes and communication to QA Manager, training opportunities stimulated from audit results
  • Collects and analyzes data to formulate recommendations and solutions based on audit trends and results and any performance gaps
  • Tracking all Health Plan audit activity from start to finish and communicating final results of any audit to the Landmark Audit Team
  • Participates in and represents in any department leadership or health plan discussions
  • Assists the business with research and documentation of workflows, policies and procedures and other materials
  • Maintains current knowledge of requirements and guidance required in the performance of audit duties
  • In the absence of a Health Plan audit, this position will backfill any duties of the QA Coding Specialist, assisting where needed
  • May be required to perform duties and responsibilities not listed in this description, on a temporary or long-term basis
  • The auditor will utilize a positive and proactive approach when working with staff to promote engagement and greater

We offer a range of market-competitive total rewards that include great compensation, career development and advancement opportunities within a fast-growing company, merit increases, paid holidays, Paid Time Off, and incentive bonus programs, medical, dental-, vision-, short- and long-term disability benefits, 401(k), life insurance, wellness programs and financial education resources. Landmark Health prides itself on being a great work-life balance employer.

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:

  • H.S. diploma or equivalent
  • Coding Certification from AACP or AHIMA professional coding association (CPC, CPC-H, CPC-P, RHIT, RHIA, CCS, CCS-P, CRC) or RN/LPN with ability to obtain coding certification from AHIMA or AAPC within 12 months of hire
  • 5+ years active coding experience with ICD diagnosis coding
  • 3+ years CMS HCC Coding Risk Adjustment experience
  • 2+ years of experience in a coding auditor/educator or mentor role
  • Solid knowledge of clinical conditions, procedures, and basic documentation requirements
  • Ability to effectively report deficiencies with a recommended solution in oral and/or written form
  • Proficiency with Microsoft Office applications to include Word, Excel, PowerPoint and Outlook

Preferred Qualifications:

  • RADV audit experience
  • Experience with a remote work environment
  • Impact of audit results could reflect in a noticeable impact in the organization and its health plan partners and may involve management attention
  • Excellent written, verbal communication and interpersonal skills, time management with solid follow-up and organizational skills; fluency in English
  • Self-directed, with minimal supervision, and the ability to collaborate effectively with various leadership teams, coding teams and health plan partners
  • Ability to make quality, independent decisions
  • Ability to work effectively and efficiently under tight deadlines, high volumes, and multiple interruptions, subject to occasional reprioritization by others
  • Solid verbal/written communication and interpersonal skills
  • Ability to perform in a deadline driven environment
  • Maintain professionalism and a positive service attitude
  • Be an exemplar of the mission, values, culture, and philosophy of the enterprise

To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment

Careers with Optum. Our objective is to make health care simpler and more effective for everyone. With our hands at work across all aspects of health, you can play a role in creating a healthier world, one insight, one connection and one person at a time. We bring together some of the greatest minds and ideas to take health care to its fullest potential, promoting health equity and accessibility. Work with diverse, engaged and high-performing teams to help solve important challenges.

Colorado, Connecticut, Nevada, or New York City Residents Only: The hourly range for Colorado residents is $26.15 to $46.63. The hourly range for Connecticut/Nevada/New York City residents is $28.85 to $51.30. Pay is based on several factors including but not limited to education, work experience, certifications, etc. 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.

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

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.