Clinical Quality Analyst

Responsibilities

• Maintain expert knowledge of coding operations and best practices to drive integration of business objectives.
• Identify and facilitate system and process standardization to reduce waste and improve KPIs and SLAs.
• Collaborate with HIM, CDI, and Coding Operations to monitor day-to-day operations and quality reviews.
• Assist leadership with oversight of initiatives designed to improve coding quality and efficiency.
• Lead coding quality assurance and compliance activities, including remediation and corrective action plans.
• Serve as a liaison between coding operations and client stakeholders to build cohesive relationships.
• Provide staff training, mentoring, and constructive feedback to ensure high accuracy and performance.
• Act as a Subject Matter Expert regarding Federal, State, and local laws and regulations.

Requirements

• High School Diploma, GED, or equivalent work experience.
• AAPC or AHIMA coding credential (e.g., CCS, CPC, RHIT, or RHIA).
• 5+ years of recent experience with IP coding and/or in a coding reviewer role.
• 1+ years of experience collaborating with CDI and Quality leadership to improve reimbursement and accuracy.
• Intermediate proficiency with Microsoft Excel, Word, PowerPoint, and SharePoint.
• Intermediate proficiency with EMR (Electronic Medical Record) and computer-assisted coding technologies.
• Ability to work full-time (40 hours/week) with flexibility for occasional overtime or weekends.

Preferred Qualifications

• 5+ years of experience in a related field.
• Experience interacting with executive, managerial, and staff-level positions across various organizational levels.
• Operational knowledge of healthcare-related Federal and State regulations and standards from agencies like CMS or TJC.

Benefits

• Comprehensive health plans and coverage to support wellness.
• Financial benefits including retirement planning and 401k contributions.
• Emotional support through tools and resources to manage stress and build resilience.
• Incentive and recognition programs.

About the Company

Optum is part of UnitedHealth Group, dedicated to helping people live healthier lives and making the health system work better for everyone. We foster a culture of integrity, compassion, inclusion, and innovation to make a meaningful difference in the lives of those we serve.