Quality Assurance Auditor

4 weeks ago

Eden Prairie, United States Optum Full time

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 start Caring. Connecting. Growing together.

You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

  • Assists with execution of the daily activities of the National Quality Assurance program o Performs first level quality audits on vendor coding results
  • Performs first level quality audits on Care Delivery coding teams coding results
  • Provides support and assists all markets within Care Delivery on various coding initiatives, such as concurrent review, query compliance audits and retrospective coding quality reviews
  • Must be able to work with multiple coding tools and EMR systems
  • Ensure that Optum Coding Guidelines are consistently applied in all processes
  • Identifies issues and trends in coding and documentation that affect coding accuracy o Provides input and valuable feedback on audit results
  • Recommends process improvement
  • Perform all other related duties as assigned
  • Perform all other related duties, such as backlog of QA1 volume, as assigned

Major Responsibilities

This role will provide coding quality auditing services to ensure compliance with Optum and CMS coding guidelines and accuracy of coding data reported. Must maintain compliance with Optum Coding Guidelines/policies. The minimum productivity goal is set by project, with minimum 96% coding accuracy rate required.

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:

  • Coding Certification required (CPC, COC, CIC, CCS, CCS-P, or RHIT; the CPC-A or CCA designation is not acceptable)
  • 4+ years of recent experience ICD-10-CM coding, preferably in a Managed Care setting, with strong attention to detail, and proficient knowledge of ICD-10-CM coding guidelines.
  • 2+ years of recent Medicare Risk Adjustment experience (HCC coding) with proficient knowledge of CMS-HCC model and guidelines
  • 1+ years of recent experience in a coding auditor role - auditing the work of other coders and providing feedback/coaching
  • Compliant Physician query experience/knowledge
  • Willing or ability to work during normal business hours, Monday-Friday 8am-5pm CST (flexibility to start 8 hour shift earlier or later after successful completion of training)
  • Willing or ability to continuously meet the requirements for a telecommuter, i.e. live in a location that can receive a UnitedHealth Group approved high speed internet connection, have a secure designated office space to maintain PHI, meet or exceed all performance expectations


Preferred Qualifications:

  • CRC (Certified Risk Coder) in addition to required coding certification
  • Inpatient coding experience
  • Microsoft Office proficiency (Word, Excel, PowerPoint & Outlook)
  • Proven excellent organizational, problem solving, and critical thinking skills
  • Proven excellent verbal/written communication and interpersonal skills

*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, or Washington Residents Only: The hourly range for this role is $23.22 to $45.43 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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