Optum is seeking a C&S Coding Clinical Analyst to review pre-payment claims and determine the accuracy of coding, billing, and payment recommendations by comparing claims to submitted medical records.
This role supports payment integrity efforts by analyzing medical documentation, applying coding guidelines, reviewing CPT/HCPCS/modifier usage, and ensuring compliance with state and federal policies. The position is telecommute-friendly and may be performed from anywhere in the U.S.
Key responsibilities include:
- Performing quality audits of clinical review cases
- Determining accuracy of medical coding and billing for pre-payment claims
- Reviewing evaluation and management coding principles
- Identifying billing trends and potential fraud, waste, or abuse
- Managing assigned caseloads and productivity metrics
- Providing clinical and coding support to internal teams
- Communicating findings in writing to providers and business partners
Required qualifications
- High School Diploma or GED
- AHIMA or AAPC certification (CPC, CCS, or CCS-P)
- 2+ years of experience as a certified coder
- 2+ years of CPT, HCPCS, ICD, and modifier coding experience
- 2+ years of experience with health insurance terminology and regulatory guidelines
- 1+ years working in a metric-driven team environment
- Intermediate experience with medical record review
- Intermediate computer skills and troubleshooting ability
- Intermediate experience with Microsoft Office and Adobe applications
Preferred qualifications
- Bachelor's degree
- Healthcare claims processing experience
- Strong communication and analytical skills
- Experience with Fraud, Waste & Abuse or Payment Integrity
- Experience with reconsideration or subsequent reviews
- Strong working knowledge of medical terminology and coding
The role includes a comprehensive benefits package, incentive and recognition programs, equity stock purchase, and 401(k) contribution, subject to eligibility requirements.
Additional highlights:
- $2,000 sign-on bonus for external applicants
- Remote work flexibility within the U.S.
Location
Minnesota, US
Employment Type
Full-time
Experience Level
Intermediate Level
Remote work allowed
Yes
Posted
3 weeks ago