Job Title: Coding Quality Analyst
Requisition Number: 2306115
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
Shift: Day Job
Telecommuter Position: Yes
About Optum
Optum is a global healthcare organization leveraging technology to help millions live healthier lives. The team connects people with care, pharmacy benefits, data, and resources. Optum promotes inclusion, offers career development, and provides comprehensive benefits.
Role Summary
The Coding Quality Analyst evaluates the accuracy of provider-submitted claims by comparing them to medical records. The role identifies suspected Waste & Error in health insurance claims, ensures compliance with state and federal guidelines, and applies clinical and coding expertise. Strong analytical skills and decision-making on complex cases are critical.
Primary Responsibilities
Conduct clinical review of CPT, HCPCS, and modifiers on claims.
Determine accuracy of coding, billing, and payment recommendations.
Consult with Medical Directors or physicians as needed.
Apply Evaluation and Management (E/M) coding principles.
Provide detailed clinical narratives on case outcomes.
Perform post-pay claim re-coding.
Ensure compliance with state/federal reimbursement policies and contracts.
Identify aberrant billing, fraud, waste, or abuse; flag providers for review.
Manage daily caseloads, adhering to quality and productivity standards.
Provide clinical expertise to investigative and analytical teams.
Participate in team and department meetings.
Work collaboratively or independently as required.
Obtain additional information from business partners as needed for clinical review.
Required Qualifications
High School Diploma/GED or higher.
Professional coder certification (CPC-A, CPC, COC, CPC-P) from AAPC, maintained annually.
2+ years as AHIMA or AAPC certified coder with experience in CPT, HCPCS, ICD-10/CM/PCS coding.
1+ year of team experience in a metric-driven environment with production and quality standards.
Intermediate knowledge of Microsoft & Adobe applications (Outlook, PowerPoint, Word, Excel, OneNote, Teams, PDF).
Preferred Qualifications
Bachelor’s degree or higher.
Registered Nurse (RN, LPN) with active license.
Experience in healthcare claims processing or Fraud, Waste & Abuse / Payment Integrity.
Strong medical record review experience.
Knowledge of health insurance business, terminology, and regulatory guidelines.
Understanding of Waste & Error principles.
Strong analytical mindset for medical terminology and coding.
Soft Skills
Highly organized with strong written and verbal communication.
Adaptable to change and new information; integrate best practices.
Professionalism and collaborative approach.
Physical Requirements & Work Environment
Frequent speaking and listening using a headset.
Prolonged sitting and keyboard use.
Navigate multiple systems simultaneously with varying complexity.
Strong computer troubleshooting skills.
Compensation & Benefits
Hourly pay: $23.41–$41.83 (full-time basis).
Comprehensive benefits package including incentives, recognition programs, equity stock purchase, and 401k contributions (eligibility applies).
Compliance & Equal Opportunity
Adhere to UnitedHealth Group Telecommuter Policy.
Equal employment consideration 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 minimizing environmental impact.
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