Optum ยท 1 month ago
Senior Coding Quality Analyst
Plymouth, MN
Full-time
Onsite
Senior Level
$23.41/hr - $41.83/hr
5+ years expOptum, in partnership with ProHealth Care, is a leader in health care services dedicated to improving community well-being. The Senior Coding Quality Analyst will assess the needs of the Ambulatory Coding Team, provide education and support to coding staff, and ensure compliance with coding standards and guidelines.
EducationHealth CareMedicalPharmaceutical
Responsibilities
Assesses and interprets needs of the Ambulatory Coding Team by prioritizing work to meet deadlines
Identifies solutions to non-standard edits, workflows, and issues
Solves complex questions and conducts analysis of trends to provide education for the coding staff and clients including physicians/providers
Provides detailed education to the Coding Team and acts as a resource to others
Train and review assignments completed by new employees and provide post-hire reviews as needed
Apply expert coding knowledge to professional coding and billing initiatives and inquiries
Identify appropriate assignment of ICD-10-CM, CPT, and HCPCS II Codes for physician services, while adhering to the official coding guidelines and established client coding guidelines of the assigned facility
Identifies aberrant billing patterns and trends, evidence of fraud, waste, or abuse, and recommends providers to be flagged for review
Understand the Medicare Ambulatory Payment Classification (APC) codes
Adhere to the ethical standards of coding as established by AAPC and/or AHIMA
Adhere to and maintain required levels of performance in both coding quality and productivity as established by Optum360
Understand federal coding register and ensure guidelines are used and followed appropriately
Understanding of appeal process with knowledge how to speak to denial and/or appeals
Provide documentation feedback to providers and query physicians when appropriate
Provide education to new onboarding providers as well as continued education to all providers
Maintain up-to-date Coding knowledge by reviewing materials disseminated/recommended by the Compliance, Coding Operations, etc
Participate/Lead in coding department meetings and educational events
Strong knowledge of coding clinics and how to obtain education information
Process Rebills as appropriate
Other duties at the discretion of the Coding Supervisor
Extensive work experience within own function
Work is frequently completed without established procedures
Works independently
May act as a resource for others
May coordinate others' activities
Extensive work experience within own function
Qualification
Required
High School Diploma/GED (or higher)
Professional coder certification with credentialing from AHIMA and/or AAPC (CPC, CCS-P, RHIA, RHIT) to be maintained annually
3+ years of Physician medical coding (ICD-10, CPT, HCPCS II) experience in a multi-specialty physician clinic
2+ years of experience with Residency Program (teaching hospital) with coding experience in complex procedures in one or more the following specialty areas: Cardiothoracic, Vascular and Cardiac Catheterizations, Neurology, Neurosurgery, OB/GYN, Hospitalist and other specialties may be applicable
2+ years of experience being able to provide expert level coding guidance to physicians, practitioners, and coders as needed
Intermediate level of knowledge of MUE and NCCI classification and reimbursement structures
Intermediate level of proficiency in a Windows PC environment, including MS Excel and with Epic and 3M Encoder
Preferred
Experience auditing charts in a professional coding environment
Experience providing physician/coding education a plus
Experience with various systems (Microsoft Teams, Encoder Pro, etc.)
Experience in Inpatient/Observation E/M coding
Intermediate level of experience with Microsoft Excel
Benefits
Comprehensive benefits package
Incentive and recognition programs
Equity stock purchase
401k contribution
Company
Optum
Optum is a healthcare company that provides pharmacy services, health care operations, and population health management. It is a sub-organization of UnitedHealth Group.
10001+ employees
H1B Sponsorship
Optum has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (648)
2024 (559)
2023 (620)
2022 (851)
2021 (593)
2020 (438)
Funding
Current Stage
Late StageLeadership Team
Daniel Castillo
Chief Executive Officer, Optum Care Delivery
J
Jay Green
Chief Financial Officer
Recent News
2025-11-29
2025-11-19
2025-11-07
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