For you, quality counts. For UnitedHealthcare, part of the UnitedHealth Group family of businesses, delivering quality care starts with processes and documentation standards that are the best in our industry. As a Senior Clinical Quality Analyst, you'll be a force for positive change, guiding the development of comprehensive care plans that will help others live healthier lives. Join us and help guide our efforts to improve the patient experience.
This role will provide expert level coding quality auditing services to ensure compliance with Optum and CMS coding guidelines and accuracy of coding data reported. This position is also responsible for timely communication of identified quality issues. This role will work with individual market leaders and other employees to ensure improvement in coding accuracy and various initiatives related to Risk Adjustment are implemented. Improvement will occur through internal and external education, innovative programs and provider engagement.
You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
* Executes the daily activities of the Enterprise Clinical Performance Quality Assurance program
* Responsible for the onboarding and training of new COE Quality Assurance Auditors
* Will lead assigned audit projects, provide direction to assigned Quality Assurance Auditors, ensuring deadlines are met and escalate any areas of concern to Senior Management as necessary
* Performs second level quality audits on vendor coding results and second level quality audit on coding / query compliance for internal Care Delivery coding teams, ensuring Quality Assurance Auditors are auditing in accordance with guidelines
* Review QA findings with Quality Assurance Auditors. Provide coaching and mentorship
* Acts as resource for coding questions and issues
* Mastery of Optum Coding Guidelines - become subject matter expert
* Ensure Optum Coding Guidelines and Compliance Policies are consistently applied in all processes
* Perform higher level compliance and other ad - hoc audits as needed
* Identify issues and analyze trends in coding and documentation. Provide input and valuable feedback to Senior Management on audit results in a timely manner
* Recommends process improvement and assists with implementation
* Collaborate with senior management to develop and revise training material based on QA results
* Provides support and assists all markets across Care Delivery with various coding / auditing initiatives as needed
* Must be able to work with multiple coding tools and EMR systems
* Develops relationships with Care Delivery Organizations and communicates guidelines and requirements to ensure correct coding and improved Provider documentation
* Cross - functional collaboration with multiple teams
* Perform all other related duties as assigned
* Associates' degree or higher (may consider certificate program / completed college coursework with significant relevant experience for degree)
* Coding Certification from AAPC or AHIMA professional coding association (CPC, RHIT, CCS)
* 7 years' experience ICD - 9 / 10 coding, with strong attention to detail and high accuracy rate
* 5 years' coding experience working in a provider's office, inpatient setting or for a Medicare Advantage health plan - can be combined experience
* 4 years' experience working with CMS Risk Adjustment guidelines (HCC Coding)
* 4 years' in a coding auditor or team lead function, reviewing the work of other coders and providing feedback on results (1 years' experience in a Risk Adjustment Quality Assurance Auditor role preferred)
* Experience provider / coder education
* Expert knowledge of ICD - 10 - CM guidelines
* Advanced knowledge of CMS - HCC model and guidelines
* Proficient experience working with multiple EMR and Coding Tool Software
* Proficient Knowledge of HEDIS / STARS
* Ability to work a flexible schedule to accommodate meetings in various time zones as needed. Monday - Friday , 8am - 5pm ( prefer central time zone)
* Self-motivated; ability to work independently in a fast paced environment with minimal supervision and guidance required
* Excellent organizational, problem solving, and critical thinking skills
* Excellent verbal / written communication and interpersonal skills
* Up to 15% travel (local, non - local meetings, national travel)
* Must be able to continuously meet the requirements for a telecommuter, i.e. live in a location that can receive a UnitedHealth Group approved high speed internet connection, have a secure designated office space to maintain PHI, meet or exceed all performance expectations
* Bachelor's degree
* 2 years supervisory experience
* 3 years' compliant physician query experience
* Microsoft Office proficiency (Word, Excel, PowerPoint & Outlook)
* 1 years HEDIS / STARS experience
* Previous experience with WebEx or similar virtual meeting tools
* Previous experience using diagnosis coding data and trends to identify training opportunities
Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)
* All Telecommuters 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.
Job Keywords: CPC, CCS, CCS-P, RHIT, CRC, auditor, risk adjustment, HCC, HEDIS, STARS, Coder, UHG, Optum, Quality Assurance, telecommute, telecommuter