[Hiring] Compliance Analyst @UnitedHealth Group

Role Description

• Conduct independent, risk-based coding compliance audits of Optum Health providers and associated clinical practices.
• Conduct coding and billing investigation audits to assess compliance with applicable coding, billing, and documentation requirements.
• Research and analyze incoming coding and billing investigation requests to support timely and accurate compliance review.
• Evaluate the accuracy, completeness, and regulatory compliance of procedure coding, including E/M services, non-E/M services, modifiers, ICD-10 coding, medical record documentation, and coding-related billing activities.
• Identify areas of compliance risk, assess adherence to CMS requirements, official coding guidelines, payer policies, and organizational standards, and support corrective action and monitoring activities.
• Prepare written audit scope memorandums that clearly define audit objectives, methodology, and review criteria.
• Identify audit findings, calculate billing error rates, and perform root cause analysis to support accurate reporting and remediation planning.
• Prepare written audit summary reports that include compliance risks, trends, findings, and recommended remediation actions.
• Research, develop, and deliver targeted education based on individual audit findings.
• Stay current with applicable coding, billing, documentation, and regulatory guidelines.
• Research, evaluate, and provide timely responses to coding compliance inquiries, ensuring alignment with applicable coding, billing, and regulatory guidance.

Qualifications

• High School Diploma/GED.
• Must possess one of the following:
  • Certified Professional Coder (CPC)
  • Certified Outpatient Coder (COC)
  • Certified Coding Specialist (CCS)
  • Certified Coding Specialist-Physician Based (CCS-P)
• 5+ years of outpatient physician coding experience, including CPT, HCPCS, ICD-10, modifiers, and NCCI edits.
• 5+ years of healthcare regulatory compliance experience, including Medicare, Medicaid, and state and federal laws and regulations governing medical coding.
• 3+ years of experience with electronic health records (EHRs) and medical record systems.
• Advanced level of proficiency with Microsoft Excel, Teams, PowerPoint, Word, and Outlook.

Requirements

• Demonstrated ability to perform independent audit and coding review functions.
• Strong professional written and verbal communication skills.
• Ability to prioritize and manage multiple assignments, spreadsheets, documents, and reports.
• Ability to gather, analyze, and organize data to support effective communication related to medical coding compliance.
• Strong time management skills with consistent follow-through to completion.

Benefits

• Comprehensive benefits package.
• Incentive and recognition programs.
• Equity stock purchase.
• 401k contribution (all benefits are subject to eligibility requirements).