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Coding Quality Analyst

Optum

Review patient medical records to extract pertinent case details, prepare defensible appeal letters, and analyze coding opportunities that may affect financial outcomes. The role requires strong knowledge of ICD-9/ICD-10-CM, ICD-10-PCS, CPT, HCPCS, encoder use, coding clinic guidance, and evidence-based medical literature. The analyst also educates clients on correct coding and compliance, participates in Administrative Law Judge tele-hearings, and completes cases within established timeframes while maintaining high-quality work.

This position allows telecommuting from anywhere within the U.S.

Requirements & Qualifications

Required Qualifications

  • High school diploma or GED
  • One of the following certifications: CCS, CCS-P, CPC-H, CPC, RHIT, RHIA, CDIP, or CCDS
  • 3+ years of inpatient hospital coding experience
  • 3+ years of experience with DRG methodology
  • 3+ years of outpatient coding experience
  • 2+ years of Medicare/Medicaid experience
  • Mastery of AHA Coding Clinic for ICD-9-CM and ICD-10
  • Intermediate computer proficiency and strong typing skills of at least 45 WPM

Preferred Qualifications

  • Associate's or bachelor's degree
  • Unrestricted RN license in state of residence
  • 3+ years of experience in ED, telemetry, or CCU
  • Auditing experience
  • Experience with Microsoft applications, internet navigation, and utilization
  • Prior experience presenting before an Administrative Law Judge

Additional Expectations

  • Strong verbal and written communication skills
  • Ability to work independently, prioritize tasks, and follow instructions
  • Collaborative team mindset
  • Compliance with HIPAA and company policies
Benefits & Perks

Comprehensive benefits package, incentive and recognition programs, equity stock purchase, and 401(k) contribution subject to eligibility requirements.

Location

Pennsylvania, US

Employment Type

Full-time

Experience Level

Senior

Remote work allowed

Yes

Posted

3 weeks ago

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