Optum · 3 hours ago
Clinical Quality Analyst Coding
Las Vegas, NV
Full-time
Onsite
Senior Level
$28.94/hr - $51.83/hr
5+ years expOptum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The Clinical Quality Analyst Coding position supports IPA Providers with ongoing ICD 10 CM Coding Education relating to Medicare Advantage - Risk Adjustment CMS Documentation & Coding Guidelines, focusing on improving health outcomes through effective training and collaboration.
EducationHealth CareMedicalPharmaceutical
Responsibilities
Provide coding and documentation improvement education and training to IPA (Independent Provider Association) providers consistent with network goals, objectives and best practices
Collaborate with organizational leaders to identify emerging needs and generate solutions
Serve as a Coding and Documentation resource to IPA Providers by performing concurrent reviews and targeted chart or HEDIS retrievals in provider offices
Coding audit findings, industry updates and common medical documentation issues will be communicated to providers to ensure CMS and Optum compliance guidelines
Will perform coding reviews through Internal System
Participate in the development and onboarding of various programs for IPA providers
Translate concepts into practice
Develop and implement effective analysis, research and evaluation of quality measures required for member demographic (Care of Older Adults (COA), Diagnostic and lab testing)
Develop and maintain working relationships with our clinic partners, including providers and their support staff in person
Ability to work with multiple internal and external partners at various levels of the organization
Adhere to project goals / milestones based on identified business needs / timelines, and obtain appropriate approvals
Adhere to established guidelines for formatting and templates
Functions as part of a collaborative, high functioning coding education team
Ability to manage multiple tasks and projects, and forge solid interpersonal relationships within the department, with other departments and with external audiences
Works with minimal guidance; seeks guidance on only the most complex tasks
Solid aptitude for quickly troubleshooting and identifying the cause of questionable results within reports, provider documentation or charges submitted
This position requires an in-person presence in various provider offices routinely
Ability to move, lift and / or push 25+ pounds
Must maintain flexibility and adjust working hours according to provider needs
Must adhere to department standards for productivity and performance
Must adhere to HIPAA Confidentiality Standards
Must be available to attend monthly IPA Team meeting in person
Generally work is self-directed and not prescribed
Works with less structured, more complex issues
Serves as a resource to others
Qualification
Required
High School Diploma/GED (or higher)
Coding Certification from AAPC or AHIMA professional coding association: (Example: CPC, CPC-H, CPC-P, RHIT, RHIA, CCS, CCS-P, CRC etc.) or RN/LPN with ability to obtain coding certification from AHIMA or AAPC within 12 months of hire
5+ years of coding experience in assignment of ICD-10 diagnostic coding
2+ years of experience with Medicare Advantage - Risk Adjustment CMS Documentation & Coding Guidelines
Advanced level of proficiency in exemplary attention to detail and completeness with a thorough understanding of government rules and regulations and areas of scrutiny for potential areas of risk for fraud and abuse regarding coding and documentation
Preferred
Associates degree in related field, or equivalent experience directly related to the duties and responsibilities of this role
2+ years of public speaking, talent development and/or education experience
Experience in developing and delivering coding education/training to non-coder professionals
Demonstrated leadership skills to include setting the example, motivating the team to be high performers and taking the initiative to achieve the outcome
Proven advanced understanding of medical terminology, pharmacology, body systems and anatomy, physiology, and concepts of disease processes
Demonstrated superior computer experience and ability to learn new computer applications quickly and independently, including: EMR(s), Microsoft Office Suite and other learning content development and publishing software programs
Demonstrated ability to manage a significant workload and to work efficiently under pressure meeting established deadlines with limited supervision
Demonstrated solid analytical, problem-solving, planning, communication, documentation, and organizational skills with meticulous attention to detail
Demonstrated ability to communicate in a clear and understandable manner, both orally and in writing; exercises independent judgment; influences and coordinate the efforts of others over whom one has no direct authority
Demonstrated ability to respond to provider requests by directing them to appropriate internal or external resources
Demonstrated ability to abide by the Standards of Ethical Coding as set forth by AHIMA and AAPC
Proven customer service centered approach and alignment with UHG Cultural Values
Driver's License and access to reliable transportation
Experience creating reports related to quality improvement/performance outcomes
Experience with quality measures such as HEDIS
Experience with Data RAP, Alliance, Facets systems and any other Electronic Medical Record
Benefits
Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays
Medical Plan options along with participation in a Health Spending Account or a Health Saving account
Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage
401(k) Savings Plan, Employee Stock Purchase Plan
Education Reimbursement
Employee Discounts
Employee Assistance Program
Employee Referral Bonus Program
Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)
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
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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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