Title: Medical Coding Auditor – Remote
Location: United States
Job Category: Customer Service and Claims
Job Type: Full-time
Travel Percentage: -1
You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
Combine two of the fastest – growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that’s improving the lives of millions. Here, innovation isn’t about another gadget, it’s about making Healthcare data available wherever and whenever people need it, safely and reliably. There’s no room for error. Join us and start doing your life’s best work.
This position is full-time (40 hours/week) Monday – Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 7:00am – 6:00pm. It may be necessary, given the business need, to work occasional overtime.
Training will be conducted virtually from your home.
*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.
- Investigate, review, and provide clinical and / or coding expertise in the application of medical and reimbursement policies within the claim adjudication process through file review. This could include Medical Director / physician consultations, interpretation of state and federal mandates, applicable benefit language, medical and reimbursement policies and consideration of relevant clinical information
- Perform clinical coverage review of claims, which requires interpretation of state and federal mandates, applicable benefit language, medical and reimbursement policies, coding requirements and consideration of relevant clinical information on claims with aberrant billing patterns
- Perform clinical coding review to ensure accuracy of medical coding and utilizes clinical expertise and judgment to determine correct coding and billing
- Knowledge of and the ability to: identify the ICD-10-CM/PCS code assignment, code sequencing, and discharge disposition, in accordance with CMS requirements, Official Guidelines for Coding and Reporting, and Coding Clinic guidance
- Must be fluent in application of current Official Coding Guidelines and Coding Clinic citations, in addition to demonstrating working knowledge of clinical criteria documentation requirements used to successfully substantiate code assignments
- Solid command of anatomy and physiology, diagnostic procedures, and surgical operations developed from specialized training and extensive experience with ICD-10-PCS code assignment
- Writes clear, accurate and concise rationales in support of findings
- Identify aberrant billing patterns and trends, evidence of fraud, waste or abuse, and recommend providers to be flagged for review
- Maintain and manages daily case review assignments, with a high emphasis on quality
- Provide clinical support and expertise to the other investigative and analytical areas
- Will be working in a high-volume production environment that is matrix drive
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 (or higher)
- 3+ years of acute care coding experience
- CCS (Certified Coding Specialist) or CIC (Certified Inpatient Coder) or Unrestricted RN (registered nurse) with CCS or CIC OR the ability to obtain certification within 6 months of hire
- Inpatient facility DRG experience (coding or auditing)
- Experience with ICD – 10 coding
- Experience with ICD – 10 – PCS
- Ability to use a Windows PC with the ability to utilize multiple applications at the same time
- RHIT (registered health information technician), RHIA (registered health information administrator), CDIP (certified documentation improvement practitioner) OR current certified facility in – patient coder
- Experience using Microsoft Excel with the ability to create / edit spreadsheets, use sort / filter function, and perform data entry
- Healthcare claims experience
- Managed care experience
- Investigation and / or auditing experience
- Knowledge of health insurance business, industry terminology, and regulatory guidelines
- Required to have a dedicated work area established that is separated from other living areas and provides information privacy
- Ability to keep all company sensitive documents secure (if applicable)
- Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service
UnitedHealth Group requires all new hires and employees to report their COVID-19 vaccination status.
Colorado, Connecticut or Nevada Residents Only: The salary range for Colorado residents is $25.63 – $45.72. The salary range for Connecticut / Nevada residents is $28.27 – $50.29. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.