[Hiring] Professional Pre-Pay 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.

• 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.
• Works 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).

Benefits

• Comprehensive benefits package.
• Incentive and recognition programs.
• Equity stock purchase.
• 401k contribution (all benefits are subject to eligibility requirements).
• Hourly pay for this role will range from $24.00 to $43.00 per hour based on full-time employment.