Remote C&S Coding Analyst – Clinical Claims & Compliance

UnitedHealth Group; Plymouth (MN); Teletrabalho; USD 50 000 - 89 000; Tempo integral

Resumo da oferta

UnitedHealth Group's Optum is seeking a C&S Coding Clinical Analyst to review provider claims against medical records, ensuring accuracy and compliance for payment decisions. Certification as AHIMA or AAPC coder and CPT/HCPCS/ICD coding experience are required.

This remote telecommute role within the United States demands analytical data interpretation, strong communication, and independent decision making. The position offers comprehensive benefits and career development opportunities.

Qualificações

• High School Diploma/GED required.
• Certified Coder AHIMA or AAPC CPC/CCS/CCS-P.
• 2+ years of AHIMA or AAPC coding experience with CPT/HCPCS/ICD/Modifiers.
• 2+ years of health insurance business terminology and regulatory guidelines.
• 1+ years in a team environment with daily production and quality standards.
• Intermediate level of computer skills and of Microsoft & Adobe applications.

Responsabilidades

• Performs quality audits of clinical review cases of CPT, HCPCS, and modifiers on claims in a telecommuting environment.
• Determines accuracy of medical coding/billing and payment recommendation for pre-payment claims.
• Consults with Medical Director/physician, interprets mandates and policies, and reviews relevant clinical information.
• Determines appropriate level of service using Evaluation and Management coding principles.
• Ensures adherence to state and federal compliance policies and contract requirements.
• Identifies aberrant billing patterns and potential fraud, waste or abuse; flags providers for review.
• Manages daily case assignments with accountability to quality, utilization and productivity.
• Provides clinical support to other investigative and analytical areas.
• Participates in team and department meetings and collaborates as needed.

Formação académica

High School Diploma/GED

Bachelor's degree

Ferramentas

Microsoft Office

Adobe Acrobat

Descrição da oferta de emprego

UnitedHealth Group's Optum is seeking a C&S Coding Clinical Analyst to review provider claims against medical records, ensuring accuracy and compliance for payment decisions. Certification as AHIMA or AAPC coder and CPT/HCPCS/ICD coding experience are required.

This remote telecommute role within the United States demands analytical data interpretation, strong communication, and independent decision making. The position offers comprehensive benefits and career development opportunities.