[Hiring] Medical Coding Auditor @UnitedHealth Group

Role Description

The Medical Coding Auditor is required to determine the accuracy of claims submitted by a provider to UnitedHealth Group by comparing it to the medical record(s) submitted for the date(s) of service being reviewed. This position supports the identification of suspected Waste & Error of health insurance claims and ensures claims are accurately documented. Candidates must be able to exercise judgement/decision making on complex payment decisions that directly impacts the provider and client by following state and government compliance guidelines, coding requirements and policies. They must confidently analyze and interpret data and medical records/documentation daily to understand historical claims activity, determine validity and demonstrate their ability to provide written communication to the provider. They are responsible to investigate, review and provide clinical and/or coding expertise in a review of claims. They need to effectively manage their caseload and monthly metrics in a production driven environment and ensure they are meeting all compliance turnaround times mandated by the client. The Coding Quality Analyst must be proficient in computer skills and able to navigate multiple systems at one time with varying levels of complexity. They must have the ability to research and work independently on making decisions on complex cases.

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

Primary Responsibilities:

• Performs clinical review of CPT, HCPCS, and modifiers assigned to codes on claims in a telecommuting work environment
• Determines accuracy of medical coding/billing and payment recommendation for claims
• 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
• Determines appropriate level of service utilizing Evaluation and Management coding principles
• Provides detailed clinical narratives on case outcomes
• Ensures adherence to state and federal compliance policies, reimbursement policies and contract compliance
• Identifies aberrant billing patterns and trends, evidence of fraud, waste, or abuse, and recommends providers to be flagged for review
• Maintains and manages daily case review assignments, with accountability to quality, utilization, and productivity standards
• Provides clinical support and expertise to the other investigative and analytical areas
• Participates in team and department meetings
• Engages in a collaborative work environment when applicable but is also able to work independently
• Serves as a clinical resource to other areas within the clinical investigative team
• Work with applicable business partners to obtain additional information relevant to the clinical review

Qualifications

• Certified Coder AHIMA (CCA, CCS, CCS-P) or AAPC Certified coder (CPC, CPC-I)
• 2+ years of experience as an AHIMA or AAPC Certified coder
• 2+ years of CPT/HCPCS/Modifiers coding experience
• 2+ years strong medical record review experience
• 1+ year of working in a team atmosphere in a metric driven environment including daily production standards and quality standards
• 1+ years of experience in the health insurance business, using industry terminology and regulatory guidelines
• 1+ years of experience in Waste & Error principles

Requirements

• Healthcare claims experience/processing experience
• Experience with Fraud Waste & Abuse or Payment Integrity
• [Internal Posting Only] 1+ year experience of UHC platforms - COSMOS, Facets, CPW, NICE, ISET, UNET
• Proficient and able to navigate and maneuver multiple systems at one time with varying levels of complexity
• Strong computer skills with the ability to troubleshoot problems
• Intermediate experience with Microsoft & Adobe applications (Outlook, Power Point, Word, Excel, OneNote, Teams, PDF)

Soft Skills

• Highly organized with effective and persuasive communication skills
• Strong written communication skills
• Open to change and new information; ability to adapt in changing environments and integrate best practices
• Strong communication skills with the ability to interpret data
• Strong analytical mindset working with medical terminology and/or coding

Benefits

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

Application Deadline

This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.