[Hiring] Coding Quality Auditor @UnitedHealth Group

Role Description

The Coding Quality Auditor is responsible for regulatory compliance audits, including but not limited to regulatory agencies, quality metrics, and coding compliance. The Auditor will monitor changes to laws and regulations to ensure compliance with State and Federal laws, regulations, and mandates. This role is responsible for client-facing meetings with the Quality Teams, CDI, and others directly related to accounts associated with prebill reviews, such as HAC/PSIs. This position must maintain solid client relationships and represent Optum360 in all aspects of its values.

You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Conduct internal monitoring/auditing of inpatient coding charts to identify process gaps and help the business address organizational risks.
• Analyze results of audits and monitoring processes to identify potential risks (e.g., risk assessments), and communicate as needed.
• Identify and analyze applicable patterns/trends (e.g., using data analysis, news reports, reported concerns) to identify potential compliance issues, and communicate as needed.
• Provide quality performance feedback by completing internal coding quality audits to the coding specialist staff, coding team leadership, and coding educators.
• Maintain and demonstrate expert knowledge of coding, coding operations, coding review of all coding staff (domestic and global) and best demonstrated coding practices.
• Serve as the expert of applicable Federal, State, and local laws and regulations, Optum360’s organizational integrity program, standards of conduct, as well as other policies and procedures.
• Communicate the potential impact of compliance issues and risks on our business, operations, and consumers to applicable stakeholders.
• Collaborate with applicable regulators (e.g., CMS) to prevent or address potential compliance issues within our organization.
• Collaborate with internal stakeholders across organization lines to help identify root causes of compliance issues, and support appropriate action to mitigate risk, as needed.
• Develop and/or deliver training on compliance issues and risks to applicable audiences.
• Consult with internal and external stakeholders to advocate and drive effectiveness of our compliance programs.
• Partner with applicable learning organizations as needed to develop/implement compliance training offerings.
• Consult with applicable business partners to identify effective approaches to support/enforce compliance within their business.
• Provide input on business training programs as needed to promote inclusion of appropriate compliance content.
• Assess and respond to the need for required compliance training among external stakeholders, as appropriate.
• Act as liaison for all external quality stakeholders which include but not limited to compliance, core measures, patient safety, and premier data integrity.
• Support coding team leadership with quality data reporting and work with coding educators on opportunities for educational topics for coders.
• Other duties as needed and assigned by Optum360 leadership.

Qualifications

• High School Diploma/GED
• AAPC or AHIMA (CCS, CPC, RHIT or RHIA) certification
• 3+ years of Inpatient Facility coding and auditing experience
• 1+ years of experience working collaboratively with CDI and quality leadership in partnership to improve reimbursement and coding accuracy
• 1+ years of experience with computer assisted coding technologies and EMR (Electronic Medical Record) coding workflow
• Intermediate level of proficiency with Microsoft Excel, Word, PowerPoint, and SharePoint
• Advanced organizational skills required (ability to multi-task, produce rapid turnaround, and effectively manage multiple projects)

Preferred Qualifications

• Outpatient coding experience in a coder or reviewer role
• Operational knowledge of health care related to Federal and State regulations, as well as standards from regulatory agencies and accrediting organizations (e.g., CMS, TJC)
• Demonstrated ability to work with a variety of individuals in executive, managerial and staff level positions.
• Demonstrated ability to possess a personal presence characterized by honesty, integrity, and caring with the ability to inspire and motivate others.

Benefits

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

Company Description

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.

We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.