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Sr. Quality Assurance Auditor - Telecommute

Company: UnitedHealth Group
Location: Eden Prairie
Posted on: January 18, 2020

Job Description:

Position Description

This role will provide expert level coding quality auditing services to ensure compliance with Optum and CMS coding guidelines and accuracy of coding data reported. This position is also responsible for timely communication of identified quality issues. This role will work with individual market leaders and other employees to ensure improvement in coding accuracy and various initiatives related to Risk Adjustment are implemented. Improvement will occur through internal and external education, innovative programs and provider engagement.

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

Primary Responsibilities:

  • Executes the daily activities of the Enterprise Clinical Performance Quality Assurance program
  • Responsible for the onboarding and training of new COE Quality Assurance Auditors
  • Will lead assigned audit projects, provide direction to assigned Quality Assurance Auditors, ensuring deadlines are met and escalate any areas of concern to Senior Management as necessary
  • Performs second level quality audits on vendor coding results and second level quality audit on coding/query compliance for internal Care Delivery coding teams, ensuring Quality Assurance Auditors are auditing in accordance with guidelines
  • Review QA findings with Quality Assurance Auditors. Provide coaching and mentorship
  • Acts as resource for coding questions and issues
  • Mastery of Optum Coding Guidelines - become subject matter expert
  • Ensure Optum Coding Guidelines and Compliance Policies are consistently applied in all processes
  • Perform higher level compliance and other ad-hoc audits as needed
  • Identify issues and analyze trends in coding and documentation. Provide input and valuable feedback to Senior Management on audit results in a timely manner
  • Recommends process improvement and assists with implementation
  • Collaborate with senior management to develop and revise training material based on QA results
  • Provides support and assists all markets across Care Delivery with various coding/auditing initiatives as needed
  • Must be able to work with multiple coding tools and EMR systems
  • Develops relationships with Care Delivery Organizations and communicates guidelines and requirements to ensure correct coding and improved Provider documentation
  • Cross-functional collaboration with multiple teams
  • Perform all other related duties as assigned

    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:
    • Associates' degree or higher (may consider certificate program/completed college coursework with significant relevant experience for degree)
    • Coding Certification from AAPC or AHIMA (CPC, RHIT, CCS)
    • 7+ years' experience ICD-9/10 coding, with strong attention to detail and high accuracy rate
    • 4+ years' experience working with CMS Risk Adjustment guidelines (HCC Coding)
    • 4+ years' in a coding auditor or team lead function, reviewing the work of other coders and providing feedback on results (1+ years' experience in a Quality Assurance Auditor role preferred)
    • Expert knowledge of ICD-10-CM guidelines
    • Advanced knowledge of CMS-HCC model and guidelines
    • Proficient experience working with multiple EMR and Coding Tool Software
    • Ability to work a flexible schedule to accommodate meetings in various time zones as needed
    • Up to 5% travel (local, non-local meetings), as needed
    • Must be able 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:
      • Bachelor's degree
      • Experience with provider/coder education
      • 2+ years supervisory experience
      • Microsoft Office proficiency (Word, Excel, PowerPoint & Outlook)
      • HEDIS/STARS knowledge
      • Previous experience with WebEx or similar virtual meeting tools
      • Previous experience using diagnosis coding data and trends to identify training opportunities
      • Self-motivated; ability to work independently in a fast paced environment with minimal supervision and guidance required
      • Excellent organizational, problem solving, and critical thinking skills
      • Excellent verbal/written communication and interpersonal skills

        If you're the kind of thinker and leader who wants to bring your contribution to a new level every day, here's your opportunity to do your life's best work.(sm)


        OptumCare is committed to creating an environment where physicians focus on what they do best: care for their patients. To do so, OptumCare provides administrative and business support services to both owned and affiliated medical practices which are part of OptumCare. Each medical practice part and their physician employees have complete authority with regards to all medical decision-making and patient care. OptumCare's support services do not interfere with or control the practice of medicine by the medical practices or any of their physicians.

        Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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.

        OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

        Job Keywords: Auditor, CMS Risk, ICD9/10, AAPC, AHIMA, CPC, RHIT, CCS, HCC, risk adjustment, provider, managed care, Medicare, telecommute, work from home, remote

Keywords: UnitedHealth Group, Minneapolis , Sr. Quality Assurance Auditor - Telecommute, Accounting, Auditing , Eden Prairie, Minnesota

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