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Coding Quality Analyst - National Remote

Company: UnitedHealth Group
Location: Hartford
Posted on: September 20, 2023

Job Description:

You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
Opportunities at Change Healthcare, part of the Optum family of businesses. We are transforming the health care system through innovative technology and analytics. Find opportunities to make a difference in a variety of career areas as we all play a role in accelerating health care transformation. Help us deliver cutting-edge solutions for patients, hospitals and insurance companies, resulting in healthier communities. Use your talents to improve the health outcomes of millions of people and discover the meaning behind: Caring. Connecting. Growing together.------
The Payment Integrity Coding Analyst researches and interprets healthcare correct coding using regulatory requirements and guidance related to CMS, CPT/AMA and other major payer policies. - They also use internal business rules to prepare written documentation of findings through medical record review. The Coding Analyst possesses an overall understanding of all coding principles, including facility and physician coding and provides health care payers with a total claim management solution. - Typically, 90% of a Coding Analyst's time is spent performing coding and documentation review and 10% spent performing other tasks as assigned.
This position is full-time, Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 6:00am - 6:00pm. It may be necessary, given the business need, to work occasional overtime.
*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.
Primary Responsibilities: -

Conduct coding reviews of medical records and supporting documentation against submitted claims, for individual provider and facility claims, to determine coding and billing accurate for all products.
Process and/or review claims in a timely manner utilizing client specific coding and billing requirements that meet or exceed production and quality goals.
Participate in process improvement activities and encourage ownership of and group participation in improvement initiatives.
Analyze medical documents to evaluate potential issues of fraud and abuse.
Document coding review findings within investigative case tracking system and maintains thorough and objective documentation of findings.
Serve as a coding resource and provide coding expertise and guidance to entire investigation team.
Identify and recommend opportunities for cost savings and improving outcomes.
Coordinate activities with varying levels of leadership including the investigative team, legal counsel, internal and external customers, law enforcement and regulatory agencies, and medical professionals through effective verbal and written communications as needed.
Research and interpret correct coding guidelines and internal business rules to respond to customer inquiries, and monitors CMS and major payer coding and reimbursement policies.
Must be able to take and pass Coding Assessment.

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 (or higher)
3+ years of experience in medical coding with primary focus in facility and physician coding.
3+ years of experience in reviewing, analyzing, and researching coding issues.
Must have one or more of the following coding credentials: - RHIA, RHIT, CCS-P, CCS or CPC
Proficiency in Microsoft Office skills including Outlook, Excel, and Word (Open/Edit/Create/Save/Send)
Ability to work full-time, Monday - Friday between 6:00am - 6:00pm including the flexibility to work occasional overtime given the business need

Preferred Qualification:

  • Associate Degree (or higher) OR equivalent in Health Information Management
    Experience with reimbursement policy and/or claims

    Telecommuting Requirements:

  • Required to have a dedicated work area established that is separated from other living areas and provides information privacy
  • Ability to keep all company sensitive documents secure (if applicable)
  • 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:

    Self-starting and independent, able to stay focused while working remotely.
    Ability to establish good customer relationships with trust and respect.
    Do you have at least one previous position that required a high level of attention to written communication?

    California, Colorado, Connecticut, Nevada, New Jersey, New York, Washington or Rhode Island Residents Only: The salary range for California / Colorado / Connecticut / Nevada / New Jersey / New York / Washington / Rhode Island residents is $22.45 - $43.89.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.

Keywords: UnitedHealth Group, Hartford , Coding Quality Analyst - National Remote, Professions , Hartford, Connecticut

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