[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.

• Exercise judgement/decision making on complex payment decisions that directly impacts the provider and client.
• Analyze and interpret data and medical records/documentation daily.
• Investigate, review and provide clinical and/or coding expertise in a review of claims.
• Manage caseload and monthly metrics in a production-driven environment.
• Ensure compliance turnaround times mandated by the client are met.
• Proficient in computer skills and able to navigate multiple systems.
• Research and work independently 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

• Perform clinical review of CPT, HCPCS, and modifiers assigned to codes on claims.
• Determine accuracy of medical coding/billing and payment recommendation for claims.
• Consult with Medical Director/physicians and interpret state and federal mandates.
• Determine appropriate level of service utilizing Evaluation and Management coding principles.
• Provide detailed clinical narratives on case outcomes.
• Ensure adherence to state and federal compliance policies, reimbursement policies, and contract compliance.
• Identify aberrant billing patterns and trends, evidence of fraud, waste, or abuse.
• Maintain and manage daily case review assignments with accountability to quality, utilization, and productivity standards.
• Provide clinical support and expertise to other investigative and analytical areas.
• Participate in team and department meetings.
• Engage in a collaborative work environment when applicable but also able to work independently.
• Serve 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.

Requirements

• Experience in the health insurance business, using industry terminology and regulatory guidelines.
• Experience in Waste & Error principles.
• 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.
• 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.
• 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 and 401k contribution (subject to eligibility requirements).
• Hourly pay for this role will range from $24.00 to $43.00 per hour based on full-time employment.

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.