Remote Clinical Investigator – Medical Coding & Audits

UnitedHealth Group; Plymouth (MN); Remote; USD 33,000 - 59,000; Full time

Benefits offered by this job

Comprehensive benefits package

Incentive and recognition programs

Equity stock purchase

401k contribution

Job summary

UnitedHealth Group is seeking a M&R Clinical Investigator to determine the accuracy of provider-submitted claims by comparing to medical records. The role requires strong coding knowledge, independent decision‑making, and compliance with government guidelines. The position offers telecommuting from anywhere in the U.S.

and a production-driven environment. The successful candidate will audit CPT/HCPCS coding, review medical necessity, and collaborate with Medical Directors and other teams to

Qualifications

• High School Diploma or GED (required)
• AHIMA or AAPC certification (CPC, CCS, CCS-P) or Nurse with active license and coding experience
• 2+ years as a certified coder with CPT/HCPCS/ICD‑10/CM/PCS experience or licensed nurse with medical record auditing experience
• 1+ year of team experience in a metric-driven environment
• Advanced medical record review experience
• Intermediate to advanced health insurance knowledge and regulatory guidelines
• Basic to intermediate experience with Microsoft & Adobe applications (Outlook, PowerPoint, Word, Excel, PDF)
• Beginner knowledge of CPT/HCPCS/Modifiers (Medical necessity and DRG review not required)

Responsibilities

• Perform quality audits of clinical review cases for CPT, HCPCS, and modifiers on claims in a telecommuting environment
• Determine accuracy of medical coding and payment recommendations for pre‑payment claims
• Consult with Medical Director/physician and interpret mandates, policy language and reimbursement rules
• Determine appropriate level of service using E/M coding principles
• Ensure compliance with state/federal policies, reimbursement rules and contracts
• Identify aberrant billing patterns and potential fraud or abuse and flag providers for review
• Manage daily case assignments with quality, utilization and productivity targets
• Provide clinical support to investigative and analytical teams
• Participate in team and department meetings
• Collaborate with business partners and research additional information as needed

Skills

Strong communication skills

Analytical mindset

Healthcare terminology

Education

AHIMA or AAPC certification (CPC/CCS/CCS-P)

Nurse license (RN/LPN)

Tools

Microsoft Office

Adobe Acrobat

Job description

UnitedHealth Group is seeking a M&R Clinical Investigator to determine the accuracy of provider-submitted claims by comparing to medical records. The role requires strong coding knowledge, independent decision‑making, and compliance with government guidelines. The position offers telecommuting from anywhere in the U.S.

and a production-driven environment. The successful candidate will audit CPT/HCPCS coding, review medical necessity, and collaborate with Medical Directors and other teams to