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Risk Adjustment Quality Assurance Auditor - Telecommute

UnitedHealth Group

Hartford, CT
Job Code:
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Job Details

Risk Adjustment Quality Assurance Auditor - Telecommute(Job Number:732335)

For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us and help people live healthier lives while doing your life's best work.(sm)


This position’s major responsibility includes assistance in execution of a coding accuracy and improvement program across all markets. This includes OptumCare Delivery's Internal Medicare Advantage Quality Review program and Coding Vendor QA.  Will also assist with other second level review programs as needed. Must maintain compliance with Optum Coding Guidelines/policies and become a subject matter expert. This role will work with individual market leaders and other employees to ensure improvement in coding accuracy and various initiatives related to Risk Adjustment are implemented. Improvement will occur through internal and external education, innovative programs and provider engagement. Perform all other related duties as assigned. The minimum productivity goal is set by project, with minimum 96% accuracy rate required.


Primary Responsibilities:

  • Assist with execution of  Internal Risk Adjustment Coding Review programs
  • Performs quality audits on vendor charts as well as Care Delivery coding teams as needed
  • Provides support and assists Care Delivery with various coding initiatives as needed
  • Ensure that Optum Coding Guidelines are consistently applied in all processes
  • Identifies issues and trends in coding and documentation that affect provider risk adjustment factor scores
  • Provides input and valuable feedback on audit results
  • Provide ICD10-CM coding training, as it relates to HCC coding, as requested
  • Develops relationships with Care Delivery and communicates guidelines and requirements of Risk Adjustment Payment System to ensure correct coding and documentation
  • Cross-functional collaboration with multiple teams and functions

Job Quality Management
Primary Location US-CT-Hartford
Other Location US-NY-Manhattan, US-TX-Houston, United States, US-CO-Denver, US-FL-Orlando, US-IL-Chicago
Organization Local Care Delivery Shared Svc
Schedule Full-time
Number of Openings 1
Apply on the Company Site

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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