Remote Clinical Coding Analyst – CPT/HCPCS Expert

ISHE; Northern (KY); Hybrid; USD 68,880,000 - 123,984,000; Full time

Benefits offered by this job

Comprehensive benefits package

Equity stock purchase

401k contribution

Job summary

UnitedHealth Group is seeking a Senior Clinical Analyst to determine the accuracy of medical claims by comparing provider records to CPT/HCPCS/ICD coding standards. The role requires independent decision making, regulatory know‑how, and strong communication across teams in a telecommuting setup.

You will audit CPT/HCPCS coding, review medical records, and ensure compliance with policies while supporting other investigative areas. A HS diploma and coder credentials are required.

Qualifications

• AHIMA or AAPC credential required (CPC/CCS/CCS-P).
• 2+ years as AHIMA or AAPC certified coder with CPT/HCPCS/ICD coding.
• 2+ years in health insurance industry knowledge and regulatory guidelines.
• 1+ year in a team-based, metric-driven environment.
• Intermediate experience with medical record review and systems troubleshooting.
• Proficient in Microsoft and Adobe applications.

Responsibilities

• Performs quality audits of clinical review cases of CPT, HCPCS, and modifiers assigned to codes on claims in a telecommuting work environment.
• Determines accuracy of medical coding/billing and payment recommendation for pre-payment claims.
• This could include Medical Director/physician consultations, interpretation of state and federal mandates, applicable benefit language, medical and reimbursement policies and consideration of relevant clinical information.
• Determines appropriate level of service utilizing Evaluation and Management coding principles.
• Ensures adherence to state and federal compliance policies, reimbursement policies and contract compliance.
• Identifies aberrant billing patterns and trends, evidence of fraud, waste or abuse, and recommends providers to be flagged for review.
• Maintains and manages daily case review assignments, with accountability to quality, utilization and productivity standards.
• Provides clinical support and expertise to the other investigative and analytical areas.
• Participates in team and department meetings.
• Engages in a collaborative work environment when applicable but is also able to work independently.
• Serves as a clinical resource to other areas within the clinical investigative team.
• Work with applicable business partners to obtain additional information relevant to the clinical review.

Skills

AHIMA certification

AAPC CPC/CCS/CCS-P

CPT/HCPCS/ICD coding

Health insurance terminology

Microsoft Office

Independent decision making

Education

High School Diploma/GED

Bachelor's degree

Tools

Microsoft Office

Adobe applications

Job description

UnitedHealth Group is seeking a Senior Clinical Analyst to determine the accuracy of medical claims by comparing provider records to CPT/HCPCS/ICD coding standards. The role requires independent decision making, regulatory know‑how, and strong communication across teams in a telecommuting setup.

You will audit CPT/HCPCS coding, review medical records, and ensure compliance with policies while supporting other investigative areas. A HS diploma and coder credentials are required.