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Senior Clinical Quality Analyst - Telecommute in Las Vegas, NV only

UnitedHealth Group

Las Vegas, NV
Job Code:
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Job Details

732062 Senior Clinical Quality Analyst Telecommute in Las Vegas NV only

Senior Clinical Quality Analyst - Telecommute in Las Vegas, NV only (732062)

Position Description

Talk about meaningful work. Talk about an important role. Let's talk about your next career move. Delivering quality care starts with ensuring our processes and documentation standards are being met and kept at the highest level possible. This means working behind the scenes ensuring a member - centric approach to care. As a Senior Quality Analyst you will monitor and support health plan quality improvement initiatives with particular emphasis on compliance with state and federal regulatory and accreditation requirements. You'll act as a voice for our members, guiding the development of comprehensive care plans that will help others live healthier lives. Here's your opportunity to discover your life's best work. (sm)

Primary Responsibilities:
  • Performs chart reviews in accordance guidelines with ICD - 10 - CM Official Guidelines and Optum Coding Guidelines
  • Performs a detailed review of medical record to identify clinical indicators
  • Provides expert level review of inpatient clinical records; identifies gaps in clinical documentation that need clarification for accurate code assignment to ensure the documentation accurately reflects the severity of the condition and acuity of care provided
  • Provides face - to - face educational opportunities with physicians
  • Utilizes only approved clarification forms
  • Conducts constant follow - up communication with providers regarding existing clarifications to obtain needed documentation specificity
  • Document audit findings in database and / or MS Excel
  • Provides complete follow through on all requests for clarification or recommendations for improvement
  • Provides constant communication with physician when needed, per the escalation process, to resolve provider issues regarding answering clarifications and participation in the clinical documentation improvement process
  • Reviews and analyzes medical record documentation in accordance with established industry and government regulations, AHA Coding Clinic, and departmental policies and procedures
  • Travel to facilities to perform chart reviews
  • Maintains a 95% quality audit accuracy rate
  • Creates performance improvement plan as needed
Required Qualifications:
  • High school education or equivalent experience
  • RHIA, RHIT, CCS, CPC, CPC-H Certification
  • 5+ years coding experience in a provider’s office, inpatient setting, or a Medicare Advantage health plan setting - can be combined experience
  • Knowledge of Risk Adjustment Hierarchal Condition Category Methodology
  • Advanced knowledge of medical terminology, pharmacology and anatomy and physiology
  • Basic Knowledge of MS Word, PowerPoint, Outlook
  • Intermediate Excel Skills
Preferred Qualifications:
  • Bachelor's degree
  • Previous Risk Adjustment auditing experience
  • Strong data analytical skills
  • Strong critical thinking skills
  • Ability to problem solve
  • Excellent written and oral communication skills
  • Ability to work independently in a fast - paced environment with minimal supervision and guidance
  • Ability to prioritize, strong organizations skills with an attention to detail

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health - related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)


Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity / Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.



Job Keywords: RHIA, RHIT, CCS, CPC, CPC-H , coding, coder, risk adjustment, ICD-10, Las Vegas, telecommute, Optum, united health group, Nevada, NV, audit, Medicare

Job Details

  • Contest Number732062
  • Job TitleSenior Clinical Quality Analyst - Telecommute in Las Vegas, NV only
  • Job FamilyMedical and Clinical Operations
  • Business SegmentOptumCare

Job Location Information

  • Las Vegas, NV
    United States
    North America

Additional Job Detail Information

  • Employee StatusRegular
  • ScheduleFull-time
  • Job LevelIndividual Contributor
  • ShiftDay Job
  • TravelYes, 50 % of the Time
  • Telecommuter PositionYes
  • Overtime StatusExempt

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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