Clinical Quality Analyst: OptumInsight

Improve the lives of others while Caring. Connecting. Growing together.

Job Description - Clinical Quality Analyst:
Optum Insight (2386170)

Clinical Quality Analyst:
Optum Insight - 2386170

Optum Insightis 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 deepexpertisein 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?
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Caring. Connecting. Growing together.

The Coding Support Subject Matter Expert (SME) serves as a vital resource within their respective health systems, offering expert level guidance and clarification on coding-related questions and issues. This role supports both coders and providers, ensuring accurate and compliant clinical documentation and coding practices across the organization. The SME uses their extensive knowledge of coding systems (e.g. ICD-10, CPT, HCPCS), payer requirements, and industry standards to respond to inquiries promptly and thoroughly.

Additionally, the SME proactively identifies trends, knowledge gaps, or recurring issues that signal the need for broader education or systemic improvements. This role plays a key part in promoting coding accuracy, compliance, and optimal revenue integrity.

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

• 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

You’llbe 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 asprovidedevelopment for other roles you may be interested in.

• AHIMA or AAPC coding credentials (e.g., CCS, CPC, RHIT, RHIA)
• 5+ years of coding experience in a healthcare setting (inpatient, outpatient, or professional coding)
• Deep understanding of ICD-10, CPT, HCPCS and official coding guidelines
• Solid written and verbal communication skills
• Proven ability to research and interpret complex coding guidelines and payer policies
• Detail oriented with solid critical thinking and problem-solving skills

• Experience providing coding support or education
• Experience with physician education or clinical documentation improvement (CDI)
• Familiarity with X EHR and Y coding tools/systems (adjust based on client)
• Knowledge of Medicare and commercial payer reimbursement…