Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring.

Connecting. Growing together.

The PNI Behavioral Health Coding Quality Analyst is responsible for coding and auditing services specific to administrative fraud, waste, and abuse cases. This includes the analysis, documentation, explanation and translation of medical and behavioral diagnosis and procedures. The Medical Coder/Analyst will support the PNI in research, issues and inquires that relate to their reviews and policies on Medical Coding/Auditing.

This position is full time Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8am - 5pm. It may be necessary, given the business need, to work occasional overtime.

We offer 4 weeks of on-the-job training. The hours of training will be aligned with your schedule.

You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities

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• Conducts reviews on records that have been identified as suspicious and/or potentially fraudulent, utilizing most current reference materials to include, but not limited to: Current Procedural Terminology (CPT), Internal Classification of Disease (ICD-9/ICD 10) and Healthcare Common Procedure Coding System (HCPCs) guidelines
• Documents Decisions on reviews through notations and enters notes in appropriate company systems
• Ability to discuss and present on decisions made to appropriate internal and external individuals/groups
• Coordinate with team members to understand trends and schemes related to billing issues/coding trends

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

• High School Diploma/GED
• Certified Coder AHIMA (CCS, CCS-P or RHIT) or AAPC Certified coder (CPC)
• Must be 18 years of age OR older 
• 2 years of coding experience in CPT medical coding
• 2 years of medical record auditing experience
• Ability to work Monday - Friday, 8am - 5pm

• Behavioral Health experience
• Experience with fraud, waste, abuse, and error
• Knowledge of CMS 1500 and UB04 data elements
• Encoder Pro familiarity

• Ability to keep all company sensitive documents secure (if applicable)
• Required to have a dedicated work area established that is separated from other living areas and provides information privacy
• Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service

• Strong oral and written communication skills
• Strong organizational/time management skills and be able to work independently or as a team
• Ability to meet production unit standards while engaging in multiple priorities