Outpatient Facility Coding Compliance Auditor | Montgomery, Alabama | Remote

UnitedHealth Group; Montgomery (AL); Remote; USD 73,000 - 130,000; Full time

Benefits offered by this job

Comprehensive benefits package

Incentive and recognition programs

Equity stock purchase and 401k

Job summary

UnitedHealth Group is seeking an Outpatient Coding Compliance Auditor. The role conducts audits of outpatient facility coding to ensure ICD-10-CM and CPT accuracy, reviews documentation, and verifies alignment with guidelines and billing standards.

You’ll identify trends, root causes, and opportunities for improvement while communicating findings to stakeholders. Responsibilities include QA coding oversight, independent reviews, and supporting organizational compliance initiatives.

Qualifications

• 5+ years of Outpatient Facility coding experience including surgical, observation and ED.
• CPC, CCS or COC certification is required; RHIA/RHIT/CPMA a plus.
• Proficient in ICD-10-CM, CPT, CPT-4 and Medicare OPPS knowledge.
• Strong independent audit and coding review capabilities with clear communication.

Responsibilities

• Perform coding compliance and quality audits for outpatient facility coding.
• Analyze clinical documentation from medical records and validate coding accuracy.
• Identify findings, calculate billing error rates and perform root-cause analysis.
• Evaluate corrective action plans and provide follow-up validation.
• Document audit results and communicate with stakeholders; develop education from findings.
• Audit vendor coders/auditors and monitor industry/regulatory updates.

Skills

Attention to detail

Strong communication

Time management

Excel / Office proficiency

Audit/analytical skills

Education

RHIA or RHIT or CPMA certification

Tools

Microsoft Excel

Microsoft Teams

PowerPoint

Word

Outlook

Job description

Outpatient Coding Compliance AuditorOptum 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 Outpatient Coding Compliance Auditor performs audits of outpatient facility (OPPS) coding to ensure accurate assignment of ICD-10-CM diagnoses, CPT/HCPCS codes, modifiers, and facility E/M levels (ACEP or client-specific). This role reviews coding for alignment with medical record documentation and established guidelines, ensuring compliance with applicable laws, regulations, and billing standards while effectively communicating findings to stakeholders. The Auditor also analyzes audit outcomes to identify trends, determine root causes, and pinpoint opportunities for improvement, as well as assess the effectiveness of corrective actions. Additionally, as part of the Compliance Workplan the Auditor participates in quality assurance (QA) coding oversight, conducts independent reviews, and supports organizational compliance initiatives.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
• Independently analyze and interpret clinical documentation from medical records
• Validate coding accuracy for outpatient facility, including E/M services, procedures, and modifiers
• Identify audit findings, calculate billing error rates, and perform root cause analysis to determine drivers of non-compliance
• Assess and evaluate the adequacy and effectiveness of corrective action plans, providing follow-up validation as appropriate
• Clearly document audit findings and articulate results tailored to the appropriate audience
• Prepare written audit analysis and summary reports, including compliance risk, trends, and recommended corrective actions
• Conduct ad hoc coding and billing audits as requested
• Provide compliance oversight of QA audit activities, ensuring consistency and adherence to established standards
• Audit vendor coders and auditors, including offshore staff
• Monitor and track evolving industry trends, regulatory updates, and government audit activities to identify potential coding and billing risk areas
• Stay current with applicable coding, billing, and regulatory guidelines
• Research, develop, and present targeted education based on individual, team, and systemic audit findings

Required Qualifications

• Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) or Certified Outpatient Coder (COC)5+ years of Outpatient Facility coding experience including:
  • NCCI/OCE billing edits related to outpatient services coding and billing
  • ICD-10-CM and CPT (including CPT-4)
  • ACEP Facility or similar Facility E/M matrix guidelines for outpatient facility code assignment
  • 5+ years of Outpatient Facility audit experience, including surgery, observation, and emergency department, including: (Strong industry knowledge of Medicare regulations and payment policies, including OPPS)
• Registered Health Information Administrator (RHIA) or Registered Health Information Technician (RHIT) or Certified Professional Medical Auditor (CPMA) a plus
• Demonstrated ability to perform independent, autonomous audit and coding review functions
• Strong professional communication skills, both oral and written
• Ability to prioritize and manage multiple assignments, spreadsheets, documents, and reports
• Proven time management skills with consistent follow-through to completion
• Proficiency with Microsoft Excel, Teams, PowerPoint, Word, and Outlook

Benefits

• 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.
• Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc.
• The salary for this role will range from $72,800 to $130,000 annually based on full-time employment.
• We comply with all minimum wage laws as applicable.

Application Deadline

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 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.