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Coding Quality Analyst - Remote in Indiana


Quality Assurance Manager


Carmel, Indiana, 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)

OptumCare is a rapidly growing national, integrated health care organization that helps physicians and other providers deliver the right care at the right time in the right setting. We design and manage delivery systems in markets where we can achieve the Quadruple Aim - a better patient experience, higher quality care, lower costs, and a better experience for providers. With our expertise and resources, we are on the front lines transforming the health care delivery system to help improve the overall health of patients and communities.

This physician led, patient centric, and data driven business creates value by delivering and facilitating care across the full continuum through high performing networks comprised of owned, managed and contracted physicians, advanced practitioners and other providers. Our system impact extends across physicians, specialty care, urgent care, home health, post-acute transitions, complex care in skilled nursing facilities and palliative care.

This position is responsible for prospective and retrospective review of the Electronic Health Record (EHR) to assist providers in more specific and complete documentation and coding. Through interaction with the physicians and other clinicians, this role facilitates improvement in the quality, completeness, and accuracy of the medical record documentation to support severity of illness, medical necessity, risk adjustment factor and level of services rendered.

This position will primarily work remotely, but candidates must be located within Indiana as occasional travel to medical practices is required.

If you are located in Indiana, you will have the flexibility to work remotely* as you take on some tough challenges

Primary Responsibilities:

  • Conducts concurrent reviews of selected patient records to address clarity, completeness, consistency, and precision of clinical documentation
  • Demonstrates understanding of clinical documentation requirements to ensure that the severity of illness, risk of mortality, and services provided are accurately reflected in the record
  • Serves as a resource on appropriate clinical documentation to support the coded conditions and risk adjustment factors
  • Communicates documentation discrepancies and coding definitions to the physicians both written and verbally as needed to clarify clinical documentation in accordance to query standards and/or policies
  • Conduct 1:1 educational sessions with physicians and other healthcare team members related to specific documentation and coding requirements
  • Collaborates and educates he multi-disciplinary team, including physicians, nurse practitioners, physician assistants, executive directors, practice managers, coding/billing staff and others regarding clinical documentation and coding best practices
  • Utilizes the electronic health record effectively
  • Effectively leverages resources to create exceptional outcomes, embraces change, and constructively resolves barriers and constraints
  • Participates in quality and performance improvement activities
  • Attends meetings and participates on committees as requested
  • Reviews current literature and attends training sessions and seminars to keep informed of new developments in the field and to maintain certification
  • Performs other related duties and responsibilities as directed

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:

  • Certified Professional Coder (CPC) or Certified Coding Specialist–Physician (CCS-P) or RHIT
  • Coding experience in physician-based settings (physician offices or group practices) or in the payer environment
  • Willingness to travel up to 25% of the time to practices within the state of Indiana

Preferred Qualifications:

  • Certified Risk Adjustment Coder (CRC)
  • Knowledge of anatomy, pathophysiology, and medical terminology necessary to correctly code diagnoses
  • Sound knowledge of medical coding guidelines and regulations
  • Expert knowledge in health information documentation, data integrity, and quality
  • A keen understanding of the impact of diagnosis coding on risk adjustment payment models
  • Understand the use of data mining from data captured through risk adjustment coding
  • Understand predictive modeling from data captured through risk adjustment coding
  • Expertise in reviewing and assigning accurate medical codes for diagnoses performed by physicians and other qualified healthcare providers in the office setting
  • Expert in ICD-10 diagnosis coding
  • Able to apply proper diagnosis code assignment under various risk adjustment models including HCC, CDPS, ACA-HHS and private payer models
  • Ability to identify and communicate documentation deficiencies to providers to improve documentation for accurate risk adjustment coding

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.

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

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.