Job Title: Coding Quality Analyst
Requisition Number: 2306046
Job Category: Medical & Clinical Operations
Primary Location: Plymouth, MN, US (Remote considered)
Business Segment: Optum
Employee Status: Regular
Job Level: Individual Contributor
Travel: No
Overtime Status: Non-exempt
Schedule: Full-time (40 hours/week, Monday–Friday)
Shift: Day Job (Flexible 8-hour schedules within 8:00am–5:00pm CST; occasional overtime as needed)
Telecommuter Position: Yes
About Optum
Optum is a global healthcare organization that delivers care through technology, connecting people with resources, pharmacy benefits, and data to improve health outcomes. The company emphasizes diversity, inclusion, career development, and comprehensive benefits.
Role Summary
The Coding Quality Analyst reviews medical claims to ensure accurate coding and compliance with state, federal, and contract guidelines. This role requires analyzing CPT, HCPCS, ICD-10/CM/PCS codes, and modifiers, providing clinical narratives, detecting fraud/waste/abuse, and supporting other investigative teams. Telecommuting is supported.
Primary Responsibilities
Perform clinical review of CPT, HCPCS, and modifiers on claims.
Determine accuracy of medical coding/billing and provide payment recommendations.
Consult with Medical Directors/physicians and interpret state/federal mandates and policies.
Determine appropriate level of service using Evaluation and Management coding principles.
Provide detailed clinical narratives on case outcomes.
Perform claim recoding.
Ensure adherence to state/federal compliance, reimbursement policies, and contract requirements.
Identify aberrant billing patterns, fraud, waste, or abuse, and flag providers for review.
Maintain and manage daily case assignments with accountability to quality, utilization, and productivity standards.
Provide clinical support and expertise to investigative and analytical teams.
Participate in team and department meetings; collaborate or work independently as required.
Serve as a clinical resource and liaise with business partners for additional information relevant to reviews.
Required Qualifications
High School Diploma/GED (or higher).
Certified Coder: AHIMA (CCS, CCS-P) or AAPC (CPC, CPC-I), or Nurse (RN, LPN) with unrestricted license, or current internal coding academy participant.
2+ years of CPT/HCPCS/ICD-10-CM/PCS coding experience.
1+ year of experience reviewing medical records in a team and metric-driven environment.
Intermediate proficiency with Microsoft & Adobe applications (Outlook, PowerPoint, Word, Excel, OneNote, Teams, PDF).
Must be 18 years or older.
Ability to work full-time with flexible 8-hour schedules; occasional overtime as required.
Preferred Qualifications
Healthcare claims processing experience.
Understanding of Waste & Error principles.
Knowledge of health insurance business, industry terminology, and regulatory guidelines.
Experience with Fraud, Waste & Abuse or Payment Integrity.
Analytical mindset with medical terminology or coding.
Telecommuting Requirements
Maintain security of company-sensitive documents.
Dedicated workspace separated from other living areas.
High-speed internet approved by UnitedHealth Group.
Adhere to UnitedHealth Group Telecommuter Policy.
Soft Skills
Strong oral and written communication.
Excellent organizational and time management skills.
Ability to work independently or collaboratively.
Ability to manage multiple priorities while meeting production standards.
Compensation & Benefits
Hourly pay: $23.41–$41.83 (full-time basis).
Comprehensive benefits package including incentives, recognition programs, equity stock purchase, and 401k contribution (eligibility applies).
Compliance & Equal Opportunity
Equal employment opportunity regardless of race, religion, gender, sexual orientation, disability, or veteran status.
Drug-free workplace; pre-employment drug test required.
Mission & Values
UnitedHealth Group is committed to equitable healthcare, reducing disparities, and improving health outcomes while mitigating environmental impact.
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