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Opportunities with Episource, part of the Optum family of businesses. Join a premier provider of risk adjustment services, software and solutions that’s fueling innovation in the health care industry. Start a rewarding career where your work will empower health plans and medical groups with comprehensive end-to-end solutions designed to navigate health care efficiently. Our culture is rooted in innovation, encouraging our team to stay curious and engaged. By joining us, you become part of a global, remote/hybrid-friendly team dedicated to bridging health care gaps with a strong sense of social responsibility. At Episource, we are enriching lives, including those of our team members through Caring. Connecting. Growing together.
Primary Responsibilities:
Derive effective QA sampling & audit methodology for the projects assigned
Perform root cause analysis, identify knowledge gaps, and conduct training to project team
Review scope document & guidelines for new clients before the start of the project and own pilot project delivery to meet client SLA on quality
Review & customize standard coding guidelines as needed
Identify error trends on client feedback & improve client experience by continuous improvements
Conduct training sessions on audit protocols, the comment matrix, and best practices for prospective auditors
Ability to respond to the internal coding queries with proper rationale
Follow external and internal compliance standards
Comply with the terms and conditions of the employment contract, company policies and procedures, and any and all directives (such as, but not limited to, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regards to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment). The Company may adopt, vary or rescind these policies and directives in its absolute discretion and without any limitation (implied or otherwise) on its ability to do so
Required Qualifications:
4+ of medical Coding experience
Worked at least 1+ year as an SME/QA
AAPC/AHIMA Certification
Knowledge on risk adjustment models - Medicare, Commercial & Medicaid
Experience in any coding specialty is preferred to handle the pilot projects
Proven well-versed in coding standards and guidelines, including ICD-10-CM guidelines, AHA coding clinic updates, and client-specific guideline requirements
Ability to perform QA audits for multiple projects
Proven analytical skills to monitor & measure the quality trend in the coding projects
Solid knowledge in Anatomy & Physiology
Preferred Qualification:
Personal Attributes/Job Specific Competencies:
Effective Planning - Competent
Goal/Objective Setting - Competent
Decision Making - Competent
Report Writing - Competent
Interpersonal Skills - Competent
Communication - Competent
Reading and Comprehension - Advanced
Taking Initiatives - Competent
Teamwork & Team Building - Basic
Ability Level:
Expert - Fully conversant with all applications of the skill/knowledge in a range of environments / would be recognized by others as expert in this skill / could be expected to train others in this skill
Advanced - Thorough understanding of skill/knowledge area / able to pass on skills in this area / recognized by colleagues as having proven skill / knowledge in this area
Competent - Sufficient skill to apply in a day-to-day operations in a fluctuating environment / does not require supervision for routine tasks
Basic - Limited understanding of skill/knowledge area. Sufficient to perform basic tasks
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.