Remote Clinical Coding Investigator – Claims & Compliance

NHSHP; Plymouth (MN); Hybrid; USD 33,000 - 59,000; Full time

Job summary

UnitedHealth Group seeks a M&R Coding Clinical Analyst to review claims for accuracy against medical records, using CPT/HCPCS/ICD coding and audits. You will apply state/federal guidelines and provide clear written communication to providers, handling complex payment decisions.

This remote role offers flexibility to telecommute from anywhere in the U.S. and requires independent work, reliable data interpretation, and collaboration to meet production and quality standards in a fast-paced

Qualifications

• Certified coder AHIMA or AAPC (CPC/CCS/CCS-P) or licensed nurse with coding/auditing experience.
• 2+ years of AHIMA or AAPC coding experience with CPT/HCPCS/ICD modifiers.
• 2+ years of health insurance terminology and regulatory guidelines.
• 1+ years in a metric-driven team environment with daily production standards.

Responsibilities

• Perform quality audits of clinical review cases for CPT, HCPCS, and modifiers.
• Determine accuracy of coding/billing and provide payment recommendations.
• Interpret state/federal mandates, benefit language, and policies for reviews.
• Determine appropriate level of service using E/M coding principles.
• Maintain adherence to compliance policies and contract requirements.
• Identify aberrant billing patterns and potential fraud or waste.
• Manage daily case assignments, ensuring quality and productivity.
• Provide clinical support to other investigative areas and teams.
• Collaborate in meetings and work independently when needed.

Skills

Medical coding knowledge

Team collaboration

Data interpretation

Problem solving

Education

High School Diploma/GED

Bachelor's degree

Tools

Microsoft Office

Adobe Acrobat

Job description

UnitedHealth Group seeks a M&R Coding Clinical Analyst to review claims for accuracy against medical records, using CPT/HCPCS/ICD coding and audits. You will apply state/federal guidelines and provide clear written communication to providers, handling complex payment decisions.

This remote role offers flexibility to telecommute from anywhere in the U.S. and requires independent work, reliable data interpretation, and collaboration to meet production and quality standards in a fast-paced