Clinical Quality Analyst - National Remote

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, Monday - Friday. Employees are required to work during our normal business hours of 8:00am - 5:00pm. It may be necessary, given the business need, to work occasional overtime.

We offer 4 weeks of on-the-job training. The hours of training will be during our normal business hours.

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 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
• Professional coder certification with credentialing from AHIMA and/or AAPC, and to be maintained annually
• Must be 18 years of age OR older
• 3+ years of E/M (evaluation & management) medical coding experience including outpatient and inpatient setting
• Ability to provide expert level coding guidance to physicians, practitioners, and coders as needed
• Ability to use a PC in a Windows environment, including Microsoft Excel
• Ability to work Monday - Friday, during our normal business hours of 8:00am - 5:00pm

Preferred Qualifications:

• Coding certification with one of the following: CPC, CCS-P, RHIA, RHIT, etc.
• Experience coding in a multi-specialty physician clinic
• Experience auditing charts in a professional coding environment
• Experience providing physician/coding education
• 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:

• Ability to communicate effectively in face-to-face and writing

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Rhode Island, Washington, Washington, D.C., Maryland Residents Only: The hourly range for this role is $28.03 to $54.95 per hour. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. 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. 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.

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.

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