Senior Quality Coding Analyst

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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale.Join us to start Caring. Connecting. Growing together.

The Senior Coding Quality Analyst performs provider encounter audits for different specialties, ad hoc provider audits for leadership, providers, and compliance, new provider audits, coder monthly audits, and ad hoc coder audits for the National Auditing Team. The Senior Coding Quality Analyst plays a critical role in maintaining coding accuracy from providers and coders, responsible for conducting complex coding audits to ensure compliance with coding guidelines.

The Senior Coding Quality Analyst contributes to the UHG success by protecting revenue integrity, ensuring audit defensibility, and supporting education initiatives that improve provider documentation.

Schedule: Monday to Friday, 8 AM- 5 PM, any time zone

Location: Remote - Nationwide

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

Primary Responsibilities:

• Perform comprehensive coding audits (E/M, CPT, HCPCS, ICD-10-CM/PCS, modifiers) for providers and coders
  Ensure coding accuracy meets or exceeds compliance benchmarks (- 95%)
• Apply current coding guidelines, CMS, OIG, and NCCI guidelines consistently
• Identify and document coding errors, trends, and potential compliance risks
• Maintain audit trails with supporting references for all findings
• Interacts with physicians and center administrators regarding documentation policies, procedures, and conflicting/ambiguous or non-specific documentation. Engage in constant communication with clinicians, clinical staff, clinical operations, and coding team to open networking and education possibilities
• Interact with coding teammates to deliver coding audit findings, discuss corrective measures and any necessary training required, and reports findings back to Coding Manager
• Provides second-level review of billing performances to ensure compliance with legal and procedural policies to ensure adherence to regulations prohibiting unbundling and other questionable practices
• Performs related work and audit projects as required

Quality Assurance & Reporting

• Mentor junior auditors and coders, providing guidance on best practices
• Collaborate with the Coding Education Team to develop targeted training sessions
• Support the design of Corrective Action Audits and follow-up audits
• Serve as a subject matter expert (SME) on coding guidelines and audit methodology

Process Improvement & Leadership Support

• Contribute to policy and standards development for national auditing practices
• Recommend workflow enhancements to streamline accuracy and reduce error rates from auditors
• Participate in cross-functional committees addressing coding accuracy, compliance, risk, and revenue integrity
• Support escalations to Compliance for fraud, waste, or abuse concerns

Core Competencies

• Integrity and commitment to compliance
• Strong organizational and time-management skills
• Ability to build relationships and foster trust across teams
• Problem-solving and process improvement mindset

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear directions 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 higher)
• Certification as a Medical Coder: CPC (AAPC), CCS (AHIMA), or CCA (AHIMA)
• 3+ years of medical coding auditing experience in a healthcare setting (payer, provider, or health system)
• Advanced level of knowledge of CPT, HCPCS, ICD-10-CM/PCS, and CMS/Medicare guidelines
• Advanced level of knowledge with auditing E/M coding, surgical procedures, and specialty coding
• Advanced level of proficiency with written and verbal communication skills
• Advanced level of proficiency in analytical skills with attention to detail and accuracy
• Advanced level of proficiency with EMR/EHR systems, auditing platforms, and Microsoft Office/Excel

Preferred Qualifications:

• Bachelor's Degree in Health Information Management, Healthcare Administration or related field
• Additional auditing certification (CPMA - Certified Professional Medical Auditor
• Experience with payer audits, risk-based auditing, or pre-bill review
• Knowledge of Epic, Athena or other enterprise EMR systems and Smartsheet
• All Telecommuters 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 $28.27 to $50.48 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

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 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.