Quality Assurance Auditor

UnitedHealth Group - Duluth, MN

Full-time | Custom_1
For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us and help people live healthier lives while doing your life's best work.(sm)

This position’s major responsibility includes assistance in execution of a coding accuracy and improvement program across all markets. This includes OptumCare Delivery's Internal Medicare Advantage Quality Review program and Vendor Coding QA. Will also assist with other second level review programs as needed. Must maintain compliance with Optum Coding Guidelines/policies and become a subject matter expert. 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. Perform all other related duties as assigned. The minimum productivity goal is set by project, with minimum 96% accuracy rate required.

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

Primary Responsibilities:
Assists with execution of the daily activities of the Enterprise Quality Assurance program
Performs first level quality audits on vendor coding results
Performs first level quality audits on Care Delivery coding teams
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; become a subject matter expert
Identifies issues and trends in coding and documentation that affect provider accuracy
Provides input and valuable feedback on audit results
Recommends process improvement
Provide ICD10-CM coding training, as it relates to HCC coding, as requested
Develops relationships with Care Delivery Organizations and assists with communication of guidelines and Risk Adjustment Program requirements to ensure correct coding and improved Provider documentation
Cross-functional collaboration with multiple teams and functions

Required Qualifications:
Associates’ degree or higher (may consider certificate program/completed college coursework or equivalent experience for degree)
Coding Certification required (CPC, CCS, CCS-P, or RHIT). CPC-A or CCA designation is not acceptable)
5+ years’ recent experience ICD-9/10 coding, preferably in a Managed Care setting, with strong attention to detail and high accuracy rate
2+ years’ recent Medicare Risk Adjustment experience (HCC coding)
1+ years’ recent experience in a coding auditor role– auditing the work of other coders and providing feedback/coaching
2+ years’ Provider interaction – communicating directly with providers
Proficient knowledge of CMS-HCC model and guidelines
ICD-10-CM proficient
Excellent organizational, problem solving, and critical thinking skills
Excellent verbal/written communication and interpersonal skills
Knowledge of HEDIS/STARS
Standard business hours Monday-Friday, 8am-5pm. M-F 8am-5pm ( prefer central time zone) with the ability to work a flexible schedule to meet business needs and accommodate meetings in various time zones as needed
Microsoft Office proficiency (Word, Excel, PowerPoint & Outlook)
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
CRC (Certified Risk Coder) in addition to required coding certification
2+ years’ coding experience working in a provider’s office or for a Medicare Advantage health plan (preferred)
Compliant Physician query experience/knowledge
1+ years HEDIS/STARS experience
Previous experience with WebEx or similar virtual meeting tools
Previous experience with data analysis and reporting
Previous experience using diagnosis coding data and trends to identify training opportunities
Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)

  • All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.
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.