Clinical Quality Analyst

Job Title

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.

Opportunities at Northern Light Health, in strategic partnership with Optum. Whether you are looking for a role in a clinical setting or supporting those who provide care, we have opportunities for you to make a difference in the lives of those we serve. As a statewide health care system in Maine, we work to personalize and streamline health care for our communities. If the place for you is at a large medical center, a rural community practice or home care, you will find it here. Join our compassionate culture, enjoy meaningful benefits and discover the meaning behind: Caring. Connecting. Growing Together.

This position is full-time (40 hours / week), Monday - Friday. Employees are required to have flexibility to work during our normal business hours of 7:00 am - 6:00 pm. Must be flexible to attend client meetings per business needs during our client business hours of Monday - Friday, 7:00 am - 4:30 pm EST. It may be necessary, given the business need, to work occasional overtime.

We offer on-the-job training. The hours of the training will be aligned with your schedule.

Primary Responsibilities

• Serve as a liaison between coding teams and providers, delivering expert guidance to resolve inquiries and concerns
• Collaborate with Edits and Denials teams to analyze trends and implement educational initiatives or system edits to address recurring issues
• Partner with clinical leadership during the introduction of new services to ensure accurate documentation and coding compliance
• Participate in specialty and physician group meetings on a quarterly basis to provide targeted coding education and respond to ad hoc inquiries
• Deliver comprehensive coding and documentation training for all newly onboarded providers
• Provide annual education to providers on code set updates to maintain compliance and accuracy
• Conduct annual provider audits to validate charges and supporting documentation, while identifying potential revenue opportunities
• Provide targeted education and follow-up audits for providers who do not meet established quality standards
• Perform ad hoc audits in response to client requests or identified concerns
• Educate coders and providers on audit findings and emerging trends to promote continuous improvement
• Assist coders and/or supervisors as needed on rebuttals for tri-annual audits
• Other duties as assigned

Required Qualifications

• High School Diploma / GED
• Professional coder certification with credentialing from AHIMA and/or AAPC (CPC, CCS-P, RHIA, RHIT) to be maintained annually
• Must be 18 years of age OR older
• 3+ years of Physician medical coding (ICD-10, CPT, HCPCS II) experience in a multi-specialty physician clinic
• 2+ years of experience with Evaluation and Management coding plus one or more areas of surgical coding
• 2+ years of experience being able to provide expert level coding guidance to physicians, practitioners, and coders as needed
• Intermediate level of knowledge of MUE and NCCI classification and reimbursement structures
• Experience with computers and Windows based programs including MS Excel
• Ability to work full-time (40 hours / week), Monday - Friday. Employees are required to have flexibility to work during our normal business hours of 7:00 am - 6:00 pm. Must be flexible to attend client meetings per business needs during our client business hours of Monday - Friday, 7:00 am - 4:30 pm EST. It may be necessary, given the business need, to work occasional overtime

Preferred Qualifications

• Experience auditing charts in a professional coding environment
• Experience providing physician/coding education a plus
• Experience in Inpatient/Observation E/M coding
• Experience with various systems (Microsoft Teams, Encoder Pro, etc.)
• Intermediate level of experience with Microsoft Excel

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

• Must be able to communicate effectively face-to-face and in writing

*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 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.