Talk about meaningful work. Talk about an important role. Let's talk about your next career move. Delivering quality care starts with ensuring our processes and documentation standards are being met and kept at the highest level possible. This means working behind the scenes ensuring a member-centric approach to care. As a Senior Quality Analyst you will monitor and support health plan quality improvement initiatives with particular emphasis on compliance with state and federal regulatory and accreditation requirements. You'll act as a voice for our members, guiding the development of comprehensive care plans that will help others live healthier lives. Here's your opportunity to discover your life's best work.(sm) UnitedHealthcare Quality Management & Performance is an integrated team serving all UnitedHealthcare businesses. We're focused on improving the health of our members, enhancing our operational effectiveness and reinforcing brand and reputation for high-quality health plans. Join us and help guide our efforts to improve the patient experience. It takes passion, commitment, intense focus and the ability to contribute effectively in a highly collaborative team environment.This role will provide ongoing auditing and feedback to our team of Medical Coders and Auditors Primary Responsibilities:Perform a detailed review of medical records to ensure the ICD-10-CM code(s) was coded correctly during the coding and / or auditing process Document audit findings in database and/or MS Excel Increase coding accuracy of coders and auditors Ensure auditors are auditing in accordance with guidelines Reviews and analyzes medical record documentation in accordance with established industry and government regulations, AHA Coding Clinic, and departmental policies and procedures Ensures the accuracy, integrity and quality of coding selections per established regulations, and they are supported by documentation, within the body of the medical record Execute the tactical day-to-day activities of the Quality Assurance process Perform, summarize and report on the Quality Assurance audits Creates performance improvement plan as needed Mastery of Optum coding guidelines, applications and practices. Subject matter expert Review QA findings with individual coders. Provide coaching and mentorship Analyze QA results and create reports Collaborate with training department to develop training materials based upon QA results Communicates with management regarding audit findings
Required Qualifications:High School Education or equivalent experience CPC, CPC-H, CCS, CCA , RHIT, or RHIA Certification 5 or more years of Medicare Risk Adjustment Coding Experience Advanced knowledge of medical terminology, pharmacology and anatomy and physiology Knowledge of Risk Adjustment Hierarchal Condition Category Methodology Basic Knowledge of MS Word, PowerPoint, Outlook Intermediate Excel Skills Preferred QualificationsBachelors' degree Previous Risk Adjustment auditing experienceSoft Skills:Strong data analytical skills Strong critical thinking skills Ability to problem solve Excellent written and oral communication skills Ability to work independently in a fast-paced environment with minimal supervision and guidance Ability to prioritize, strong organizations skills with an attention to detailCareers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care 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)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. Job Keywords: Senior QA Auditor, Risk Adjustment, Brentwood, TN, Tennessee
Our mission is to help people live healthier lives and to help make the health system work better for everyone.- We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities. - We work with health care professionals and other key partners to expand access to quality health care so people get the care they need... at an affordable price. - We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions.