Remote C&S Coding Analyst - Claims Review & Audit

Colorado Psychiatric; Northern (KY); Hybrid; USD 33,000 - 59,000; Full time

Benefits offered by this job

Comprehensive benefits

Incentive programs

Equity stock purchase plan

401k contribution

Job summary

UnitedHealth Group seeks a C&S Coding Clinical Analyst to validate claims against medical records in a telecommuting role across the U.S. You will evaluate coding accuracy and provide expert input for pre-payment claims, complying with state and federal policies.

The role requires AHIMA/AAPC certification, 2+ years of coding experience, strong analytical and communication skills, and proficiency with MS Office and Adobe. Remote access is supported.

Qualifications

• High School Diploma or GED required.
• AHIMA or AAPC Certified coder (CPC, CCS, CCS-P) is required.
• 2+ years of AHIMA or AAPC coding experience with CPT/HCPCS/ICD/Modifiers experience.
• 2+ years of health insurance industry experience.
• 1+ years in a metric-driven team environment.
• Intermediate medical record review experience.
• Intermediate computer skills.
• Intermediate MS Office & Adobe applications.

Responsibilities

• Performs quality audits of clinical review cases for CPT, HCPCS, and modifiers in a telecommuting environment.
• Determines accuracy of medical coding/billing and payment recommendations for pre-payment claims.
• May involve Medical Director/physician consultations and interpretation of mandates and policies.
• Determines appropriate level of service using E/M coding principles.
• Ensures adherence to state and federal compliance policies and contract terms.
• Identifies aberrant billing patterns and potential Fraud, Waste & Abuse.
• Maintains daily case review assignments with quality, utilization and productivity standards.
• Provides clinical support to investigative and analytical areas.
• Participates in team and department meetings.
• Works collaboratively but can operate independently as needed.
• Serves as a clinical resource within the team.
• Works with partners to obtain additional information for the clinical review.

Skills

Clinical coding proficiency

Team collaboration

Analytical thinking

Computer literacy

Communication skills

Education

High School Diploma/GED

Bachelor's degree (preferred)

Tools

Microsoft Office Suite

Adobe Acrobat/Reader

Job description

UnitedHealth Group seeks a C&S Coding Clinical Analyst to validate claims against medical records in a telecommuting role across the U.S. You will evaluate coding accuracy and provide expert input for pre-payment claims, complying with state and federal policies.

The role requires AHIMA/AAPC certification, 2+ years of coding experience, strong analytical and communication skills, and proficiency with MS Office and Adobe. Remote access is supported.