Senior Coding Quality Assurance - Remote
UnitedHealth Group - eden prairie, MN
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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 You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities: Evaluates clinical coding directives in educational materials to ensure accurate and compliant coding Recommends new instructional processes to ensure consistent and efficient coding practices Provide guidance to Education Solutions team on changes to coding guidelines as needed Participates in meetings, onboarding sessions, and trainings as a content expert on coding-specific issues Review documentation and coding for accuracy and compliance Compile ICD-10-CM, CPT, etc., sets for organizational use in creating suspecting language. Ensure alignment of ICD-10-CM codes with clinical chart reviews and coding operations Serve as a resource during new suspect development and review meetings Perform updates of coding guidelines in a variety of capacities Provides support and assist with various coding initiatives, such as internal concurrent review, eHC mapping, coding compliance initiatives and retrospective coding quality reviews Ensure that Optum Coding Guidelines are consistently applied in all processes Provides input and valuable feedback on audit results Recommends process improvement Serve as internal resource in medical coding - sharing knowledge and expertise for educational materials Review ICD-10-CM guidelines and codes within educational documents for accuracy and consistency Participate in a variety of meetings, trainings, and onboarding sessions, available to answer coding specific questions Assist with regular CMS coding updates to ensure accurate and compliant materials Provides feedback and works with Clinical Documentation Improvement Educator to develop targeted education and training to improve accuracy Develops relationships with clinical providers and communicates coding and documentation guidelines and requirements of the Risk Adjustment program to ensure correct coding and documentation, if required by client Work with assigned providers, network managers, medical director, market leader, stakeholders and/or other employees to ensure improvement in coding accuracy, as necessary Perform all other related duties as assigned 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 or GED equivalent Coding Certification from AAPC or AHIMA (CPC, RHIT, CCS) 6+ years ICD-10 and CPT coding, with solid attention to detail and high accuracy rate 4+ years Medicare Risk Adjustment/HCC Coding Proficient experience working with multiple EMR and Coding Tool Software Expert knowledge of ICD-10-CM guidelines Advanced knowledge of CMS-HCC model and guidelines Ability to work a flexible schedule to accommodate meetings in various time zones as needed Ability to work during normal business hours, Monday-Friday 8am-5pm CST (flexibility to start 8-hour shift earlier or later after successful completion of training) Ability 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 Preferred Qualifications: RHIA or RHIT Certifications Certified Risk Adjustment Coder Managed care experience Pharmacology knowledge Working knowledge of CPT/Evaluation and Management guidelines Development and delivery of ICD-10-CM documentation and coding education Proven excellent organizational, problem solving, and critical thinking skills Proven excellent verbal/written communication and interpersonal skills *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Rhode Island, Washington or Washington, D.C. Residents Only: The hourly range for this role is $28.03 to $54.95 per hour. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. 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. Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. 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.
Created: 2024-10-13