Coding Quality Analyst - Hybrid - Tampa, FL
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)
The Coding Quality Analyst demonstrates proficiency in all aspects of outpatient coding. The Coding Quality Analyst performs medical chart audits for evaluation, management, and documentation. This role also interfaces and disseminates audit results to clinicians and management and supports the Billing and Collection team on the review of coding edits.
- Consistently exhibits behavior and communication skills that demonstrate commitment to superior customer service, including quality and care and concern with each and every internal and external customer
- Represents the Company in a professional manner, following all Company policies and procedures
- Uses, protects, and discloses patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards
- Complies with all aspects of Coding and Corporate Compliance standards
- Abides by all ethical standards and adheres to official coding guidelines
- Conducts physician chart audits to identify incorrect coding, prepares reports of findings and any compliance issues
- Reports coding patterns identified within the audit process to the Manager, and identifies corrective measures to compliance problems
- Maintaining current knowledge of coding guidelines and relevant federal regulations through the use of current CPT-4, HCPCS II, and ICD-10 materials, the Federal Register, and other pertinent materials
- Interacts with physicians and center administrators regarding billing and documentation policies, procedures, and conflicting/ambiguous or non-specific documentation
- Provides second-level review of billing performances to ensure compliance with legal and procedural policies to ensure adherence to regulations prohibiting unbundling and other questionable practices
- Review coding issues and process claim corrections as needed. claims, and rejections from clearing house and process corrections as needed. Assists in the preparation of training materials
- Maintains confidentiality
- Performs related work and projects as required
- Performs other duties as assigned
- Must have consistent, punctual, and reliable attendance
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.
- High School diploma or GED
- Certified Coder (based on specific organizations) Or equivalent Certification
- 2+ years of coding experience in a Primary Care environment
- Experience with Risk and Fee For Service Coding
- Experience with Claims Coding and Revenue Cycle
- Knowledge of Risk Adjustment and Hierarchical Condition Categories (HCC) and Medicare Advantage reimbursement
- Excellent understanding of medical terminology, disease process and anatomy and physiology
- Excellent understanding of ICD-10-CM coding classification
- Excellent understanding of CPT coding within a Primary Care environment
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.
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.