Coding Quality Analyst

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

Job Description - Coding Quality Analyst (2393994)

Coding Quality Analyst - 2393994

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 Clinical Professional Coding Analyst supports the Pre-Pay Claims Validation (PPCV) product within Commercial Fraud, Waste, Abuse, and Error for external commercial clients.

In this role, you will perform complex clinical coding reviews to identify coding inaccuracies, documentation gaps, and opportunities to improve claim accuracy. Responsibilities include reviewing medical records and claims documentation, conducting coding analysis, supporting audit and validation activities, documenting findings and recommendations, and collaborating with internal and external partners to promote coding accuracy, quality, and compliance. The role also contributes to process improvement initiatives, coding education, and client-specific requirements.

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that is improving the lives of millions. Here, innovation is not about another gadget; it is about making health care data available wherever and whenever people need it, safely and reliably. There is no room for error.

If you are looking for a better place to use your passion and your desire to drive change, this is the place to be. It's an opportunity to do your life's best work.

You will enjoy the flexibility to telecommute
* from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Perform clinical review of professional claims and supporting medical records to determine whether billed services are supported in accordance with applicable coding, reimbursement, and documentation requirements
• Maintain departmental productivity, quality, and accuracy standards as established by leadership
• Develop and communicate clear, concise, and defensible clinical rationales for review determinations
• Analyze claim, provider, and medical record data to identify discrepancies, billing concerns, and reimbursement opportunities
• Investigate, evaluate, and resolve claim review findings for commercial, government, and health plan customers
• Ensure compliance with applicable state and federal regulations, reimbursement policies, contractual requirements, and internal review guidelines
• Utilize critical thinking and clinical expertise to identify, research, and resolve issues within the scope of responsibility
• Accurately document review findings, determinations, and supporting rationale in applicable systems

Internal Collaboration and Customer Support:

• Attend team, department, and cross-functional meetings to provide feedback, share operational insights, and contribute to continuous improvement initiatives
• Partner with internal stakeholders across departments to identify opportunities, address challenges, and promote collaboration, accountability, and operational excellence
• Respond to internal and external inquiries and provide subject matter expertise to support business operations and organizational objectives
• Maintain effective working…