Quality Assurance Specialist

Chennai, Tamil Nadu
Permanent
Full-time

22 days ago

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 start Caring. Connecting. Growing together.Primary Responsibilities:

Be able to perform QA audits for multiple projects
Derive effective QA sampling & audit methodology for the projects assigned
Possess analytical skills to monitor & measure the quality trend in the coding projects
Perform root cause analysis, identify knowledge gaps, and conduct training to project team
Review scope document & guidelines for new clients before the start of the project and own pilot
project delivery to meet client SLA on quality
Review & customize standard coding guidelines as needed
Identify error trends on client feedback & improve client experience by continuous improvements
Conduct training sessions on audit protocols, the comment matrix, and best practices for prospective auditors
Be able to respond to the internal coding queries with proper rationale
Follow external and internal compliance standards
Comply with the terms and conditions of the employment contract, company policies and procedures, and any and all directives (such as, but not limited to, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regards to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment). The Company may adopt, vary or rescind these policies and directives in its absolute discretion and without any limitation (implied or otherwise) on its ability to do so

Required Qualifications:

Educational Background: Degree in Life Sciences or Medical/Paramedical Sciences
Certifications: Valid AAPC or AHIMA certification is required
Experience: 3+ years of experience HCC Risk Adjustment Coding
Knowledge on risk adjustment models – Medicare & Commercial
Well-versed in coding standards and guidelines, including ICD-10-CM guidelines, AHA coding clinic updates, and client-specific guideline requirements

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

UnitedHealth Group

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