Senior Coding Quality Analyst
Today• Walnut Creek, CA
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, Monday - Friday. Employees are required to work 8-hour shifts between 6 AM and 6 PM. It may be necessary, given the business need, to work occasionally overtime or weekends.
You'll enjoy the flexibility to telecommute from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:
- Assesses and interprets the needs of the Ambulatory Coding Team by prioritizing work to meet deadlines.
- Identifies solutions to non-standard edits, workflows, and issues.
- Solves complex questions and conducts analysis of trends to provide education for the coding staff and clients including physicians/providers.
- Provides detailed education to the Coding Team and acts as a resource to others.
- Train and review assignments completed by new employees and provide post-hire reviews as needed.
- Apply expert coding knowledge to professional coding and billing initiatives and inquiries.
- Identify appropriate assignment of ICD-10-CM, CPT, and HCPCS II Codes for physician services, while adhering to the official coding guidelines and established client coding guidelines of the assigned facility
- Understand the Medicare Ambulatory Payment Classification (APC) codes
- Adhere to the ethical standards of coding as established by AAPC and/or AHIMA
- Adhere to and maintain required levels of performance in both coding quality and productivity as established by Optum360
- Understand federal coding register and ensure guidelines are used and followed appropriately.
- Understanding of appeal process with knowledge how to speak to denial and/or appeals.
- Provide documentation feedback to providers and query physicians when appropriate
- Maintain up-to-date Coding knowledge by reviewing materials disseminated/recommended by Compliance, Coding Operations, etc.
- Participate in coding department meetings and educational events
- Strong knowledge of coding clinics and how to obtain education information.
- Process Rebills as appropriate.
- Other duties at the discretion of the Coding Supervisor
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What are the reasons to consider working for UnitedHealth Group? Put it all together - competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include:
- Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays
- Medical Plan options along with participation in a Health Spending Account or a Health Saving account
- Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage
- 401(k) Savings Plan, Employee Stock Purchase Plan
- Education Reimbursement
- Employee Discounts
- Employee Assistance Program
- Employee Referral Bonus Program
- Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)
- More information can be downloaded at: http://uhg.hr/uhgbenefits
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)
- Professional coder certification with credentialing from AHIMA and/or AAPC (CPC, CCS-P, RHIA, RHIT) to be maintained annually
- 3+ years of Physician medical coding (ICD-10, CPT, HCPCS II) experience in a multi-specialty physician clinic
- Expert level of experience working in a level II trauma center and/or teaching hospital with a mastery of complex procedures in one or more the following specialty areas: Cardiothoracic, Vascular and Cardiac, Urology, Oncology, Gastroenterology, General Surgery, OB/GYN, Hospitalist, Primary Care, and other specialties may be applicable
- Expert level of experience with professional E/M coding
- Intermediate level of knowledge of OCE, MUE and NCCI classification and reimbursement structures
- Ability to use a PC in a Windows environment, including MS Excel and various EMR systems
- Must be able to communicate effectively face-to-face and in writing
- Must be able to provide expert level coding guidance to physicians, practitioners, and coders as needed
Preferred Qualifications:
- Experience auditing charts in a professional coding environment
- Experience providing physician/coding education
- Experience with various systems (CACp,EPIC, Allscripts, IDX, RCX, Encoder Pro)
- Intermediate level of experience with Microsoft Excel
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 $28.27 to $50.48 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): Walnut Creek, CA
Job ID: UHG-2306335
Employment Type: FULL_TIME
Posted: 2025-08-29T00:54:08
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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