Remote Coding Investigator: Medical Claims & Compliance

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

Benefits offered by this job

Telecommuter Policy

Job summary

UnitedHealth Group seeks a M&R Coding Clinical Analyst to verify provider claims against medical records and determine payment validity in line with state and federal guidelines. This remote role requires strong analytical skills, CPT/HCPCS/ICD coding experience, and the ability to research complex cases while adhering to compliance timelines.

The Senior Recovery Resolution Analyst will manage caseloads, collaborate with Medical Directors, and navigate multiple systems to deliver accurate coding

Qualifications

• High School Diploma or GED required.
• AHIMA or AAPC coding certification or active nurse license with medical record auditing experience.
• 2+ years coding experience with CPT/HCPCS/ICD/Modifiers.
• 2+ years health insurance industry knowledge.
• 1+ years in a metric-driven team environment.
• Intermediate medical record review experience.
• Strong computer skills to troubleshoot issues across multiple systems.
• Basic experience with Microsoft and Adobe applications.

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.
• Interprets state and federal mandates and policies with clinical information.
• Determines appropriate level of service using E/M coding principles.
• Ensures adherence to compliance and reimbursement policies.
• Identifies aberrant billing patterns and flags for review.
• Manages daily case review assignments with quality and productivity standards.
• Provides clinical support to investigative and analytical areas.
• Participates in team and department meetings; works independently when needed.
• Collaborates with business partners to obtain additional information.

Skills

Strong communication skills

Proficient computer skills

Healthcare coding knowledge

Education

High School Diploma/GED

Bachelor's degree

Tools

Microsoft Office

Adobe Acrobat

CPT/HCPCS/ICD coding systems

Job description

UnitedHealth Group seeks a M&R Coding Clinical Analyst to verify provider claims against medical records and determine payment validity in line with state and federal guidelines. This remote role requires strong analytical skills, CPT/HCPCS/ICD coding experience, and the ability to research complex cases while adhering to compliance timelines.

The Senior Recovery Resolution Analyst will manage caseloads, collaborate with Medical Directors, and navigate multiple systems to deliver accurate coding