UnitedHealth Group

Clinical Quality Analyst

UnitedHealth Group • $60K — $108K *
Bangor, ME 04401In-Person
Hospitals & Medical Centers
Less than 5 years of experience
1 week ago
Job Overview by Ladders

Qualifications

  • High School Diploma or GED required.
  • Professional coder certification from AHIMA and/or AAPC is mandatory, maintained annually.
  • At least 3 years of experience in Physician medical coding in a multi-specialty physician clinic.
  • Minimum of 2 years of surgical coding experience in a Residency Program setting.
  • Intermediate knowledge of MUE and NCCI classification and reimbursement structures required.
  • Proficient in a Windows PC environment, especially MS Excel and Epic.

Responsibilities

  • Act as a liaison between coding teams and healthcare providers to resolve issues and concerns.
  • Work with Edits and Denials teams to analyze trends and develop educational initiatives.
  • Collaborate with clinical leadership to ensure documentation and coding compliance for new services.
  • Conduct quarterly specialty and physician group meetings to provide coding education.
  • Deliver training for newly onboarded providers on coding and documentation best practices.
  • Perform annual audits of provider documentation to identify revenue opportunities and validate charges.
  • Provide follow-up education and audits for providers who fail to meet quality standards.

Benefits

  • Comprehensive benefits package including health, dental, and vision insurance.
  • Incentive and recognition programs to reward performance.
  • Options for equity stock purchase and a 401(k) contribution plan.
  • A culture that emphasizes transparency in directions for success and professional development opportunities.
Full Job Description


Primary Responsibilities

  • 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'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear directions on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

  • High School Diploma/GED
  • Professional coder certification with credentialing from AHIMA and/or AAPC (CPC, CCS-P, RHIA, RHIT) to be maintained annually
  • 3+ years of Physician medical coding (ICD-10, CPT, HCPCS II) experience in a multi-specialty physician clinic
  • 2+ years of experience with Residency Program (teaching hospital) with surgical coding experience in Evaluation and Management plus one or more of the following: Neurology + one or more of the following, Breast Surgery, Dermatology, Endocrinology, Gastroenterology, Oncology, Opthalmology, Optometry, Oral Surgery, Otorhinolaryngology, Pain Management, Physiatry, Podiatry, Pulmonary Medicine, Rheumatology, Sleep Medicine, Urology, Vascular Care, Wound Care
  • 2+ years of experience being able to provide expert level coding guidance to physicians, practitioners, and coders as needed
  • Intermediate level of knowledge of MUE and NCCI classification and reimbursement structures
  • Intermediate level of proficiency in a Windows PC environment, including MS Excel and with Epic


Preferred Qualifications:

  • Experience auditing charts in a professional coding environment
  • Experience providing physician/coding education a plus
  • Experience with various systems (Microsoft Teams, Encoder Pro, etc.)
  • Experience in Inpatient/Observation E/M coding
  • Intermediate level of experience with Microsoft Excel


Soft Skills:

  • Must be able to communicate effectively face-to-face and in writing


*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy.

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $29.00 to $52.00 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

About UnitedHealth Group

UnitedHealth Group is a medical facility. They offer health technology, health finance, and pharmacy services. They are utilizing clinical data and intelligence to assist in the redesign, automation, and deployment of technology to streamline administrative operations and clinical decision-making. Payment systems for both consumers and providers are critical components of a health-care system.

UnitedHealth Group Careers

Joining UnitedHealth Group means becoming part of a diverse team dedicated to making a difference. As a leader in health services and innovation, our company offers a variety of job opportunities that allow professionals to leverage their skills, drive innovation, and improve lives. Work You’ll Do At UnitedHealth Group, you’ll contribute to a mission-focused environment where your expertise will influence the health and well-being of people worldwide. Our employment opportunities span across a wide range of disciplines, from healthcare specialists to data analysts, ensuring that your career journey is both dynamic and rewarding. Transform Healthcare with Your Expertise UnitedHealth Group stands at the forefront of health innovation. Our team collaborates to deliver solutions that lead to better patient outcomes. Working with us, you’ll find yourself at the intersection of technology, healthcare, and leadership, providing key insights that drive industry transformation. Join Our Global Team As part of our team, you’ll engage with over 300,000 professionals globally, dedicated to building a diverse and inclusive workplace. UnitedHealth Group is not just a company; it’s a community where you can grow your career through continuous learning and leadership opportunities. Our commitment to diversity training ensures that every team member can thrive. UnitedHealth Group Career Development We are committed to your professional growth. Explore career paths filled with promising job opportunities and internships that will harness your potential and expand your capabilities. Whether you’re a seasoned professional or a recent graduate, you’ll find that our career development programs support your ambition at every level. Innovative Work Environment At UnitedHealth Group, innovation is at the core of our operations. We encourage our team to bring forward-thinking ideas that challenge the status quo and lead to breakthrough improvements in patient care. Be Part of a Great Team Our culture fosters a collaborative and supportive environment where every member’s contribution is valued. Enjoy the benefits of being part of a global team that’s committed to making a difference in people’s lives. Future-Proof Your Career With UnitedHealth Group, your career is future-proof. Dive into a range of positions that offer both challenges and rewards. Our robust support system includes unmatched training, development programs, and certification support to propel your career forward. Stay Connected Join Our Team Discover the right position that matches your skills and interests. We are always hiring and look for passionate, curious, and solution-driven team players. Search UnitedHealth Group jobs today and take the first step towards a fulfilling career. Keep Up to Date Stay informed with career tips, insider perspectives, and industry-leading insights you can use today—all from the people who work here. Read Careers Blog Job Alert Emails Customize your subscription to receive job alerts, the latest news, and insider tips tailored to your preferences. Explore the exciting and rewarding opportunities that await at UnitedHealth Group.
Learn more about UnitedHealth Group
Size
350,000 employees
Market Cap
$493.1 billion
Industry
Healthcare
Net Income
$15.4 billion
Founded
1974
5 Year Trend
+9.2%
Revenue
$257.1 billion
NASDAQ
UNH
* Ladders Estimates

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