Remote Clinical Documentation & Coding Specialist

University of Minnesota School of Nursing; Eden Prairie (MN); Hybrid; USD 73,000 - 130,000; Full time

Benefits offered by this job

Telecommuting

Job summary

UnitedHealth Group is seeking a qualified Medical Code Reviewer to perform DRG validations, review ICD-10 coding, and ensure medical necessity. The role is remote within the United States and requires AHIMA or AAPC certification along with several years in health insurance claims.

You will collaborate with Medical Directors and Utilization Management to identify overpayments and support payment integrity initiatives, including retrospective data mining and pre-payment cost avoidance.

Qualifications

• High School Diploma / GED or equivalent work experience.
• Certified coder with AHIMA or AAPC ex. RHIA, RHIT, CPC, CIC.
• 5+ years of experience in the health insurance industry.
• 2+ years of experience with health insurance claims and inpatient DRG coding.
• 2+ years of experience with medical records review.
• 2+ years of facility claims experience.
• Proficiency in performing financial analysis / audits.
• Ability to work Monday - Friday, 7:00 am - 5:00 pm CST.

Responsibilities

• Perform DRG validation reviews and confirm DRG assignments.
• Maintain current knowledge of ICD-10 coding principles and CMS regulations.
• Review medical records to apply medical and reimbursement policies.

Skills

DRG coding

ICD-10 coding

Medical records review

Financial analysis

Education

High School Diploma or GED

Tools

CES (Claims Editing System)

CMS regulations knowledge

Job description

UnitedHealth Group is seeking a qualified Medical Code Reviewer to perform DRG validations, review ICD-10 coding, and ensure medical necessity. The role is remote within the United States and requires AHIMA or AAPC certification along with several years in health insurance claims.

You will collaborate with Medical Directors and Utilization Management to identify overpayments and support payment integrity initiatives, including retrospective data mining and pre-payment cost avoidance.