Per Diem Clinical Quality Analyst (SME)

$58,302 - $114,296/Yr

UnitedHealth Group - Dallas, TX

Part-time - Entry Level

Remote - Dallas, TX

Insurance Carriers and Related Activities

About the position

The Per Diem Clinical Quality Analyst (SME) role at Optum involves providing technical expertise in the Risk Quality and Provider Enablement division. The position focuses on quality audits, coaching, and supporting abstraction teams for HEDIS® measures. This part-time role allows for remote work and requires flexibility in scheduling, particularly during peak seasons.

Responsibilities

• Participate in Medical Record spot audits
• Serve as a Subject Matter Expert of NCQA's HEDIS® Technical Specifications for all HEDIS® Retrospective, Prospective and Administrative Measures
• Provide leadership and participation on abstraction/overread office hours
• Review and respond to abstraction and overread questions and rebuttals
• Responsible for reviewing all overread failures in the OQGA tool
• Assist with resolving abstraction logic errors as needed
• Learn, understand and apply HEDIS®/CMS measure knowledge
• Work in a self-directive manner and apply critical thinking/problem solving skills
• Meet team and departmental productivity expectations while maintaining quality standards
• Observe and comply with policies and procedures for assigned scope
• Conduct Quality Assurance and Vendor Inter-Rater Reliability (VIRR)
• Perform Medical Record Review Validation (MRRV) and Inter-Rater Reliability (IRR)
• Interpret medical charts and perform data entry for abstraction
• Provide 1:1 coaching with abstractor/overreader when quality issues are identified
• Provide feedback related to annual system updates for MRR abstraction tool
• Participate in developing/pulling reporting documents for progress and results of abstraction

Requirements

• High School Diploma / GED
• 18 years of age or older
• 2+ years of healthcare experience
• 2+ years of experience reviewing medical records
• 1+ year of HEDIS® experience with a focus on medical record review and clinical oversight
• Ability to use Microsoft applications such as Outlook
• Ability to complete full training needs during the first week of class
• Ability to work nights and/or weekends during peak seasons as needed
• Ability to work per diem (up to 20 hours/week) from January - April

Nice-to-haves

• Coding certificate from AAPC or AHIMA OR Clinical Certification such as LPN, RN, or CNA
• 2+ years of experience in a health care delivery organization
• Knowledge of Medicaid and/or Medicare programs
• Proficiency in presentation skills to audiences of various sizes
• Knowledgeable of current trends in HEDIS® in managed health care
• Knowledgeable of NCQA, Stars, HEDIS®, HOS and CAHPS requirements
• Familiarity with ICD-9-CM, CPT, DRG, LOINC, HCPCS, TOB, POS, NDC coding

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution