Clinical Quality Analyst Coding

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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

Schedule : Monday through Friday from 8 : 30 am to 5 : 00 pm

Location :

2716 North Tenaya Way, Las Vegas, NV 89128

The Clinical Quality Analyst Coding position supports IPA (Independent Provider Association) Providers with ongoing ICD 10 CM Coding Education relating to Medicare Advantage - Risk Adjustment CMS Documentation & Coding Guidelines by providing tools to allow for greater meaningful information exchange to allow providers to identify potential new clinical conditions early, reinforce self-care and prevention strategies, coordinate care, improve overall patient outcomes. This position will be responsible for effectively training clinical documentation skills for complete reporting of medical diagnoses to build an accurate health profile for each individual member.

Primary Responsibilities :

Provide coding and documentation improvement education and training to IPA (Independent Provider Association) providers consistent with network goals, objectives and best practices

Collaborate with organizational leaders to identify emerging needs and generate solutions

Serve as a Coding and Documentation resource to IPA Providers by performing concurrent reviews and targeted chart or HEDIS retrievals in provider offices

Coding audit findings, industry updates and common medical documentation issues will be communicated to providers to ensure CMS and Optum compliance guidelines

Will perform coding reviews through Internal System

Participate in the development and onboarding of various programs for IPA providers

Translate concepts into practice

Develop and implement effective analysis, research and evaluation of quality measures required for member demographic (Care of Older Adults (COA), Diagnostic and lab testing)

Develop and maintain working relationships with our clinic partners, including providers and their support staff in person

Ability to work with multiple internal and external partners at various levels of the organization

Adhere to project goals / milestones based on identified business needs / timelines, and obtain appropriate approvals

Adhere to established guidelines for formatting and templates

Functions as part of a collaborative, high functioning coding education team

Ability to manage multiple tasks and projects, and forge solid interpersonal relationships within the department, with other departments and with external audiences

Works with minimal guidance; seeks guidance on only the most complex tasks

Solid aptitude for quickly troubleshooting and identifying the cause of questionable results within reports, provider documentation or charges submitted

This position requires an in-person presence in various provider offices routinely

Ability to move, lift and / or push 25+ pounds

Must maintain flexibility and adjust working hours according to provider needs

Must adhere to department standards for productivity and performance

Must adhere to HIPAA Confidentiality Standards

Must be available to attend monthly IPA Team meeting in person

Generally work is self-directed and not prescribed

Works with less structured, more complex issues

Serves as a resource to others

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

Coding Certification from AAPC or AHIMA professional coding association : (Example : CPC, CPC-H, CPC-P, RHIT, RHIA, CCS, CCS-P, CRC etc.) or RN / LPN with ability to obtain coding certification from AHIMA or AAPC within 12 months of hire

5+ years of coding experience in assignment of ICD-10 diagnostic coding

2+ years of experience with Medicare Advantage - Risk Adjustment CMS Documentation & Coding Guidelines

Advanced level of proficiency in exemplary attention to detail and completeness with a thorough understanding of government rules and regulations and areas of scrutiny for potential areas of risk for fraud and abuse regarding coding and documentation

Preferred Qualifications

Associates degree in related field, or equivalent experience directly related to the duties and responsibilities of this role

2+ years of public speaking, talent development and / or education experience

Experience in developing and delivering coding education / training to non-coder professionals

Demonstrated leadership skills to include setting the example, motivating the team to be high performers and taking the initiative to achieve the outcome

Proven advanced understanding of medical terminology, pharmacology, body systems and anatomy, physiology, and concepts of disease processes

Demonstrated superior computer experience and ability to learn new computer applications quickly and independently, including : EMR(s), Microsoft Office Suite and other learning content development and publishing software programs

Demonstrated ability to manage a significant workload and to work efficiently under pressure meeting established deadlines with limited supervision

Demonstrated solid analytical, problem-solving, planning, communication, documentation, and organizational skills with meticulous attention to detail

Demonstrated ability to communicate in a clear and understandable manner, both orally and in writing; exercises independent judgment; influences and coordinate the efforts of others over whom one has no direct authority

Demonstrated ability to respond to provider requests by directing them to appropriate internal or external resources

Demonstrated ability to abide by the Standards of Ethical Coding as set forth by AHIMA and AAPC

Proven customer service centered approach and alignment with UHG Cultural Values

Driver's License and access to reliable transportation

Experience creating reports related to quality improvement / performance outcomes

Experience with quality measures such as HEDIS

Experience with Data RAP, Alliance, Facets systems and any other Electronic Medical Record

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.

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.

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