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 diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.
The Outpatient Coding Compliance Auditor conducts audits of outpatient facility and/or professional services coding to validate the integrity of ICD-10-CM diagnoses, CPT, HCPCS, modifiers and/or professional Evaluation and Management(E/M) codes assigned for all specialties and chart types. The Auditor validates assigned codes for accuracy based on medical record documentation and established ICD-10-CM, CPT-4 coding guidelines, along with modifier usage. Audits include reviewing code assignments to validate consistency with relevant laws, regulations, coding, and billing standards, communicating relevant citations to the coder. The auditor analyzes audit results to identify patterns and trends.
You’ll enjoy the flexibility to work remotely* from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:
- Perform coding compliance and quality audits in support of Optum Insight Provider’s Compliance Program and client expectations
- Analyze and interpret documentation from medical records
- Clearly document audit findings and calculate billing error rates
- Provide feedback and education as appropriate depending on findings
- Articulate audit findings appropriate to the audience
- Prepare written audit analysis and summary reports, including corrective action necessary to mitigate risk
- Conduct ad hoc coding and billing audits as requested
- Assist client organization with internal or external Compliance reviews
- Audit vendor coders and auditors, including offshore staff
- Stay abreast of relevant coding and billing guidelines
- Research, develop and present education to coders based on individual and team audit analysis
- Conduct auditor peer review audits as requested
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:
- Certified Professional Coder (CPC) or Certified Outpatient Coder (COC)
- 5+ years of Outpatient Facility Coding Experience, including ICD-10 - CM and CPT procedure coding
Preferred Qualifications:
- Certified Coding Specialist (CCS) or Certified Coding Specialist-Physician Based (CCS-P) or Registered Health Information Administrator (RHIA) or Registered Health Information Technician (RHIT) or Certified Professional Medical Auditor (CPMA)
- 5+ years of Professional Services Coding experience
- 5+ years of Outpatient Facility and/or Professional Services audit experience, including surgery
- Extensive experience with various documentation and Electronic Medical Records
- Extensive experience in all Outpatient chart types including outpatient surgery, observation, emergency department and ancillary services.
- Expert knowledge of NCCI/OCE billing edits as it relates to outpatient and/or professional services coding and billing
- Evaluation & Management Guidelines for Professional Services
- Leveling facility evaluation and management codes
- Thorough knowledge of American College of Emergency Physician (ACEP) Facility or similar
- Industry knowledge of Medicare regulations and payment policies, including OPPS
- Proficient in computer applications such as Microsoft Excel, Teams, PowerPoint, Word, and Outlook
- Professional communication skills, oral and written
- Proven ability to manage time efficiently and follow through on duties to completion
- Proven ability to prioritize multiple assignments and multiple spreadsheets, documents and reports
Careers with Optum. Our objective is to make health care simpler and more effective for everyone. With our hands at work across all aspects of health, you can play a role in creating a healthier world, one insight, one connection and one person at a time. We bring together some of the greatest minds and ideas to take health care to its fullest potential, promoting health equity and accessibility. Work with diverse, engaged and high-performing teams to help solve important challenges.
California, Colorado, Connecticut, Nevada, New Jersey, New York, Rhode Island, or Washington Residents Only : The salary range for California, Colorado, Connecticut, Nevada, New Jersey, New York, Rhode Island or Washington residents is $67,800 to $133,100. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.
*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy
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.
Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.