Clinical Quality Analyst

Requisition number: 2378077

Job category: Medical & Clinical Operations

This position is National Remote. You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Optum Insight is improving the flow of health data and information to create a more connected system. We remove friction and drive alignment between care providers and payers, and ultimately consumers. Our deep expertise in the industry and innovative technology empower us to help organizations reduce costs while improving risk management, quality and revenue growth. Ready to help us deliver results that improve lives? 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 shift schedules during our normal business hours of 8:00 am - 5:00 pm EST. It may be necessary, given the business need, to extend hours and work occasional overtime or weekends as needed.

We offer weeks of on-the-job training. The hours of the training will be aligned with your schedule. Training will be conducted virtually from your home.

Primary Responsibilities:

• Maintains and demonstrates expert knowledge of coding, coding operations, coding review of all coding staff (domestic and global) and best demonstrated coding practices; drives the integration of Optum360 Coding related business objectives within the client environment

• Identifies & builds consensus for facilitation of system and process standardization, utilization of best practices, work integration, change management, issue resolution, metric development and measurement, and communication related to the key components of coding operations:

• Executes the integration of the Optum360 Coding functions and processes in the facilities they serve

• Leverages standard processes, systems, or other vehicles to reduce waste and cost at the facility while improving SLAs, KPIs (Key Performance Indicators), metrics and the overall client and/or patient experience

• Works collaboratively with HIM, CDI, and Coding Operations to monitor day-to-day coding operations, prebill coding reviews, and prebill quality reviews

• Assists Coding Leadership with oversight of processes and initiatives designed to continuously improve coding quality and/or efficiency

• Maintains expert knowledge of coding to ensure high level of accuracy and proficiency standards of performance are achieved to meet or exceed targets

• Effectively leads and participates in coding quality assurance/compliance activities that include action plans relevant to audit results including remediation, education, and when appropriate assisting to create and monitor corrective action plans *internal audits for global partners

• Serves as the liaison between the coding operations collaboratively bring each unit together including establishing, building, and maintaining cohesive relationships with the client

• Effectively utilizes tools and data provided to capture and continually improve union, client, and employee engagement

• Leads initiatives towards meeting and exceeding employee satisfaction

• Leads by example; promotes teamwork by fostering a positive, transparent, and focused working environment which achieves maximum results

• Participates actively in leadership forums at the system level and leads such forums and other informational/educational offerings for assigned HIM/Coding/CDI Managers

• Provides team leadership and promotes successful business operation by:

• Fosters teamwork atmosphere between business and clinical stakeholders

• Provides staff training and mentoring

• Provides development of employees through consistent and constructive feedback geared towards accuracy

• Rewards and recognizes performance and provides leadership direction during the common review process

• Seeks to innovate and foster innovative ideas toward the development of staff to ensure increased employee engagement and employee satisfaction

• Other duties as needed and assigned by Optum360 leadership, including but not limited to leading and conducting special projects. Develop project work plans, facilitate resource allocation, execute project tasks and obtain assistance from other intra and inter-departmental resources, as required

• Subject Matter Expert of applicable Federal, State, and local laws and regulations, Optum360's organizational integrity program, standards of conduct, as well as other policies and procedures to ensure adherence in a manner that reflects honest, ethical, and professional behavior

• Promotes a service-oriented culture within the organization and assures satisfaction with the quality and amount of support provided for departmental functions, initiatives, and projects

• Internal audits for global partners

• All duties as assigned

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 equivalent work experience

• AAPC or AHIMA (CCS, CPC, RHIT or RHIA) coding credential

• Must be 18 years of age OR older

• 5+ years of recent experience with IP coding (DRG, ICD-10 CM/PCS) and a coding reviewer role

• 1+ years of experience working collaboratively with CDI and Quality leadership in partnership to improve reimbursement and coding accuracy

• Intermediate level of proficiency with Microsoft Excel, Word, PowerPoint, and SharePoint

• Intermediate level of proficiency with computer assisted coding technologies and EMR (Electronic Medical Record) coding workflow

• Ability to work full-time (40 hours/week) Monday - Friday. Employees are required to have flexibility to work any of our shift schedules during our normal business hours of 8:00 am - 5:00 pm EST. It may be necessary, given the business need, to extend hours and work occasional overtime or weekends as needed

Preferred Qualifications:

• 5+ years of experience in related field

• Ability to work with a variety of individuals in executive, managerial and staff level positions. The incumbent frequently interacts with staff at the Corporate/National, Regional and Local organizations. May also interact with external parties, such as financial auditors, third party payer auditors, consultants, and various hospital associations

• Operational knowledge of health care related Federal and State regulations, as well as standards from regulatory agencies and accrediting organizations (e.g., CMS, TJC)

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:

• Excellent organizational skills (ability to multi-task, produce rapid turnaround, and effectively manage multiple projects)

• Exemplary level ability to influence change and serve as primary change agent

• Must possess a personal presence that is characterized by a sense of honesty, integrity, and caring with the ability to inspire and motivate others to promote the philosophy, mission, vision, goals, and values of Optum360 and our client organization(s)

*All employees working remotely 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 $29.00 to $52.00 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

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 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.