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Conduct reviews on suspicious or potentially fraudulent records using CPT, ICD, and HCPCS guidelines. Document decisions in company systems and coordinate with team members to identify billing and coding trends.
Requirements
Requires a High School Diploma/GED and an active coding certification from AHIMA or AAPC. Candidates must have at least 2 years of experience in both CPT medical coding and medical record auditing.
Full job description
Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best.Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale.Join us to start Caring. Connecting. Growing together.
The Coding Quality Analyst position is full time 40hours/week Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8am - 5pm CST. It may be necessary, given the business need, to work occasional overtime.
We offer 4 weeks of on-the-job training. The hours of training will be aligned with your schedule.
You’ll enjoy the flexibility to telecommute from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities
Conducts reviews on records that have been identified as suspicious and/or potentially fraudulent, utilizing most current reference materials to include, but not limited to: Current Procedural Terminology (CPT), Internal Classification of Disease (ICD-9/ICD 10) and Healthcare Common Procedure Coding System (HCPCs) guidelines
Documents Decisions on reviews through notations and enters notes in appropriate company systems
Ability to discuss and present decisions made to appropriate internal and external individuals/groups
Coordinate with team members to understand trends and schemes related to billing issues/coding trends
You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:
High School Diploma/GED
Active and unrestricted coding certification from AHIMA (CCS, CCS-P or RHIT) or AAPC (CPC)
2+ years of coding experience in CPT medical coding
2+ years of medical record auditing experience
Ability to work full time 40hours/week Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8am - 5pm CST. It may be necessary, given the business need, to work occasional overtime
Must be 18 years of age or older
Preferred Qualifications:
Behavioral Health experience
Experience with fraud, waste, abuse, and error
Knowledge of CMS 1500 and UB04 data elements
Encoder Pro familiarity
Telecommuting Requirements:
Ability to keep all company sensitive documents secure (if applicable)
Required to have a dedicated work area established that is separated from other living areas and provides information privacy
Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service
Soft Skills:
Strong oral and written communication skills
Strong organizational/time management skills and be able to work independently or as a team
Ability to meet production unit standards while engaging in multiple priorities
All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you’ll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $24.00 to $43.00 per hour based on full-time employment. We comply with all minimum wage laws as applicable.
Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.
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.
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. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.
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, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.
#RPO #GREEN
Related keywords
Medical CodingCoding Quality AnalystAHIMAAAPCCCSCCS-PRHITCPCCPTICD-10ICD-9HCPCSMedical AuditingFraud Waste and AbuseCMS 1500UB04
UnitedHealth Group is a health care and well-being company with a mission to help people live healthier lives and help make the health system work better for everyone.
We are 340,000 colleagues in two distinct and complementary businesses working to help build a modern, high-performing health system through improved access, affordability, outcomes and experiences.
Optum delivers care aided by technology and data, empowering people, partners and providers with the guidance and tools they need to achieve better health. UnitedHealthcare offers a full range of health benefits, enabling affordable coverage, simplifying the health care experience and delivering access to high-quality care.
We work with governments, employers, partners and providers to care for 147 million people and share a vision of a value-based system of care that provides compassionate and equitable care.
At UnitedHealth Group, our mission calls us, our values guide us and our diverse culture connects us as we seek to improve care for the consumers we are privileged to serve and their communities.
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More about UnitedHealth Group can be found at unitedhealthgroup.com/
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