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Profee SME Clinical Quality Analyst - Dallas, United States - Optum
Description
You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.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 startCaring. Connecting. Growing together.
This position is full-time.
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.
It may be necessary, given the business need, to work occasional overtime and weekends.We offer 4 weeks of paid training. The hours during training will be 8:00am to 5:00pm, Monday - Friday.
*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.
Primary Responsibilities:
Assesses and interprets 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 the 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
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
3+ years of physician (pro-fee) medical coding experience in a multi-specialty physician clinic
2+ years of experience providing consultation and/or education to physicians and practitioners on coding guidelines and requirements
Professional coder certification with credentialing from AHIMA and/or AAPC (CPC, CCS-P, RHIA, RHIT) to be maintained annually
Expert level coding experience with a mastery of complex procedures in one or more the following specialty areas: Cardiothoracic, Vascular and Cardiac Catheterizations, Orthopedics, Neurology, Neurosurgery, General Surgery, OB/GYN, Hospitalist, and other specialties may be applicable.
Intermediate proficiency in Microsoft Office Suite
Proficiency in various EMR software (i.e., EPIC, Cerner, AllScripts, 3M, etc.)
Experience with Inpatient and Outpatient E/M (evaluation management) coding
Must have experience with ICD-10, CPT, and HCPCS II
Ability to travel up to 25%
Must be 18 years of age OR older
Ability to work full-time between 8:00am - 5:00pm including the flexibility to work occasional overtime given the business need
Preferred Qualifications:
Experience auditing charts in a professional coding environment
Experience with various Encoder systems
Knowledge of Medicare Ambulatory Payment Classification (APC) codes
Firm understanding of federal coding guidelines
Understanding of appeals/denials process
Knowledge of coding clinics and how to obtain educational information
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.
Soft Skills:
Exceptional communication - both written and verbal
California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Washington or
Rhode Island Residents Only:
The hourly range for California / Colorado / Connecticut / Hawaii / Nevada / New York / New Jersey / Washington / Rhode Island residents is $ $54.95 per hour.
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.
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.#RPO
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