Remote Clinical Coding Analyst: Claims Compliance

Rhode Island Bar Assn.; Albuquerque (NM); Remote; USD 33,000 - 59,000; Full time

Job summary

UnitedHealth Group's Optum division seeks a C&S Coding Clinical Analyst to determine the accuracy of claims by comparing provider submissions to medical records, applying CPT/HCPCS/ICD guidelines, and providing written communications to providers. The role supports pre-payment reviews and requires analytical judgment in a production-driven environment.

This is a remote position with telecommute flexibility from anywhere in the U.S.

Qualifications

• High School Diploma or GED.
• AHIMA or AAPC Certified coder (CPC, CCS, CCS-P).
• 2+ years as AHIMA/AAPC certified coder with CPT/HCPCS/ICD/Modifiers – 10/CM/PCS experience.
• 2+ years in health insurance business, terminology, and regulatory guidelines.
• 1+ years in a metric-driven, production-focused team environment.
• Intermediate medical record review experience.
• Intermediate computer skills and problem solving abilities.
• Intermediate experience with Microsoft & Adobe (Outlook, PowerPoint, Word, Excel, PDF).

Responsibilities

• Performs quality audits of clinical review cases in a telecommuting environment.
• Determines accuracy of medical coding/billing and payment recommendations for pre-payment claims.
• Consult with Medical Directors/physicians on mandates, policies and relevant clinical information.
• Determines appropriate level of service using Evaluation and Management coding principles.
• Ensures adherence to state/federal compliance and reimbursement policies.
• Identifies aberrant billing patterns and flags potential fraud, waste or abuse.
• Manages daily case review assignments with quality and productivity targets.
• Provides clinical support to other investigative/analytical areas.

Skills

Coding experience

Healthcare terminology

Regulatory knowledge

Problem solving

Communication skills

Team oriented

Education

High School diploma

Bachelor's degree

Tools

Outlook

PowerPoint

Word

Excel

PDF

Job description

UnitedHealth Group's Optum division seeks a C&S Coding Clinical Analyst to determine the accuracy of claims by comparing provider submissions to medical records, applying CPT/HCPCS/ICD guidelines, and providing written communications to providers. The role supports pre-payment reviews and requires analytical judgment in a production-driven environment.

This is a remote position with telecommute flexibility from anywhere in the U.S.