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.
The Coding Quality Analyst
is responsible for Investigating Optum Waste and Error stopped claims by gathering information, researching state and federal guidelines, and following internal procedure to determine the viability of the claim for further review in a production environment.
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. Will pick schedule to work with manager after training. It may be necessary, given the business need, to work occasional overtime.
We offer weeks of paid training. The hours of the training will be based on schedule or will be discussed on your first day of employment.
All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.
Primary Responsibilities:
- Perform clinical review of professional claims vs. medical records to determine if the claim is supported or unsupported.
- Maintain standards for productivity and accuracy. Standards are defined by the department.
- Provide clear and concise clinical logic to the providers when necessary.
- Attend and provide feedback during monthly meetings with assigned internal customer department.
- Provide continuous feedback on how to improve the department relationships with internal team members and departments.
- Keep up required Coding Certificate and/or Nursing Licensure.
- Complete compliance hours as required by the department.
The pace is fast, so your ability to multi-task is essential. You should also enjoy working with people and have the communication skills necessary to build strong relationships with our patients.
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
- 2+ years of experience with claims auditing and researching claims information.
- Working knowledge of the healthcare insurance and/or managed care industry.
- Previous experience in claim processing, healthcare provider information, or healthcare billing practices
- Working knowledge of medical terminology and claim coding.
- Knowledge of claims processing systems and guidelines/processes
- Proficient with personal computers, including Microsoft Suite of products. (Open, create, edit, send)
- Required Coding Certificate (any listed below or equivalent): Must have one of the following:
- Certified Professional Coder (CPC)
- Certified Professional Medical Auditor (CPMA)
- Certified Coding Specialist (CCS)
- Medical record coding experience with experience in Evaluation and Management Services in the outpatient/ medical office setting.
- Must be 18 years of age OR older
- Ability to work any of our 8-hour shift schedules during our normal business hours. Will pick schedule to work with manager after training. It may be necessary, given the business need, to work occasional overtime.
Preferred Qualifications:
- 1+ years of experience in a coding role
- Experience with Microsoft Office
- Previous presentation or policy documentation experience
- Knowledge of Medicaid/Medicare Reimbursement Methodologies
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:
- Strong customer service skills.
- Ability to work in a team.
- Strong analytical and problem-solving skills.
- Strong written and verbal communications skills.
California, Colorado, Connecticut, Nevada, New Jersey, New York, Washington or Rhode Island Residents Only: The hourly range for California / Colorado / Connecticut / Nevada / New York / New Jersey / Washington / Rhode Island residents is $22.45 – $43.89 per hour. 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.
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.
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