Clinical Quality Analyst Coding (Winchester)

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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to startCaring. Connecting. Growing together.

Schedule: Monday through Friday from 8:30 am to 5:00 pm

Location: 2716 North Tenaya Way, Las Vegas, NV 89128

The Clinical Quality Analyst Coding position supports IPA (Independent Provider Association) Providers with ongoing ICD 10 CM Coding Education relating to Medicare Advantage - Risk Adjustment CMS Documentation & Coding Guidelines by providing tools to allow for greater meaningful information exchange to allow providers to identify potential new clinical conditions early, reinforce self-care and prevention strategies, coordinate care, improve overall patient outcomes. This position will be responsible for effectively training clinical documentation skills for complete reporting of medical diagnoses to build an accurate health profile for each individual member.

Primary 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 questionab