Coding Quality Analyst
Today• Plymouth, MN
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.
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 of 8:00am - 5:00pm CST. It may be necessary, given the business need, to work occasional overtime.
We offer 2 weeks of on-the-job training. The hours of the training will be aligned with your schedule.
You will enjoy the flexibility to telecommute from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities
- Performs clinical review of CPT, HCPCS, and modifiers assigned to codes on claims in a telecommuting work environment.
- Determines accuracy of medical coding/billing and payment recommendation for claims.
- This could include Medical Director/physician consultations, interpretation of state and federal mandates, applicable benefit language, medical and reimbursement policies and consideration of relevant clinical information.
- Determines appropriate level of service utilizing Evaluation and Management coding principles.
- Provides detailed clinical narratives on case outcomes.
- Perform claim recoding
- Ensures adherence to state and federal compliance policies, reimbursement policies and contract compliance.
- Identifies aberrant billing patterns and trends, evidence of fraud, waste, or abuse, and recommends providers to be flagged for review.
- Maintains and manages daily case review assignments, with accountability to quality, utilization, and productivity standards.
- Provides clinical support and expertise to the other investigative and analytical areas.
- Participates in team and department meetings.
- Engages in a collaborative work environment when applicable but is also able to work independently.
- Serves as a clinical resource to other areas within the clinical investigative team.
- Work with applicable business partners to obtain additional information relevant to the clinical review.
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)
- Certified Coder AHIMA (CCS, CCS-P) or AAPC Certified coder (CPC, CPC-I) or Nurse (RN, LPN) with unrestricted license, or currently in coding academy (internal)
- 2+ years of experience as an AHIMA or AAPC Certified coder with 2+ years of CPT/HCPCS/ICD - 10/CM/PCS coding experience or Licensed nurse with medical record auditing and coding/billing experience
- 1+ years of experience working in a team atmosphere in a metric driven environment including daily production standards and quality standards
- 1+ years of experience with CPT/HCPCS/Modifiers (Medical necessity and DRG review experience is not applicable to this position)
- 1+ years of experience working with reviewing medical records
- Intermediate level of experience with Microsoft & Adobe applications (Outlook, Power Point, Word, Excel, OneNote, Teams, PDF)
- Must be 18 years of age or older
- Ability to work full-time, 8:00am - 5:00pm CST including the flexibility to work occasional overtime given the business need
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Preferred Qualifications:
- Healthcare claims experience/processing experience.
- Understanding of Waste & Error principles
- Knowledge of health insurance business, industry terminology, and regulatory guidelines.
- Experience with Fraud Waste & Abuse or Payment Integrity.
- Analytical mindset working with medical terminology or coding.
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.
All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $23.41 to $41.83 per hour based on full-time employment. We comply with all minimum wage laws as applicable.
Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.
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.
UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.
#RPO #GREEN
Client-provided location(s): Plymouth, MN
Job ID: UHG-2306046
Employment Type: FULL_TIME
Posted: 2025-09-03T20:16:33
Perks and Benefits
Health and Wellness
- HSA
- On-Site Gym
- HSA With Employer Contribution
- Health Insurance
- Dental Insurance
- Vision Insurance
- Life Insurance
- Short-Term Disability
- Long-Term Disability
- FSA
Parental Benefits
- Non-Birth Parent or Paternity Leave
- Birth Parent or Maternity Leave
Work Flexibility
- Remote Work Opportunities
Office Life and Perks
- Commuter Benefits Program
Vacation and Time Off
- Leave of Absence
- Personal/Sick Days
- Paid Holidays
- Paid Vacation
Financial and Retirement
- Relocation Assistance
- Performance Bonus
- Stock Purchase Program
- 401(K) With Company Matching
- 401(K)
Professional Development
- Promote From Within
- Shadowing Opportunities
- Access to Online Courses
- Tuition Reimbursement
Diversity and Inclusion
- Diversity, Equity, and Inclusion Program
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