Remote Healthcare Coding Compliance Auditor

UnitedHealth Group; Eden Prairie (MN); Remote; Confidential; Full time

Job summary

UnitedHealth Group is seeking a healthcare coding compliance auditor to conduct independent audits of providers and clinical practices. This role focuses on documentation, CPT/ICD-10 accuracy, and CMS policy adherence.

You must have CPC/COC/CCS/CCS-P and 5+ years of outpatient coding and regulatory compliance experience, with strong Excel and EHR familiarity. Telecommuting options are available within the U.S.

Qualifications

• High School Diploma or GED is required.
• Must possess one of the following certifications: CPC, COC, CCS, or CCS-P.
• 5+ years of outpatient physician coding experience including CPT, HCPCS, ICD-10, modifiers, and NCCI edits.
• 5+ years of healthcare regulatory compliance experience including Medicare, Medicaid, and state/federal laws.

Responsibilities

• Conduct independent, risk-based coding compliance audits of providers and associated clinical practices.
• Conduct coding and billing investigation audits to assess compliance with coding, billing, and documentation requirements.
• Research and analyze audit requests to support timely compliance review.
• Evaluate accuracy, completeness, and regulatory compliance of procedure coding and billing activities.
• Identify compliance risks and support corrective action and monitoring activities.
• Prepare audit scope memorandums and summary reports with findings and remediation actions.
• Develop education based on audit findings and stay current with coding guidelines.

Skills

Independent audits

Risk-based auditing

Medical coding

Education

CPC

COC

CCS

CCS-P

High School Diploma

Tools

Microsoft Excel

Microsoft Teams

PowerPoint

Microsoft Word

Outlook

Job description

UnitedHealth Group is seeking a healthcare coding compliance auditor to conduct independent audits of providers and clinical practices. This role focuses on documentation, CPT/ICD-10 accuracy, and CMS policy adherence.

You must have CPC/COC/CCS/CCS-P and 5+ years of outpatient coding and regulatory compliance experience, with strong Excel and EHR familiarity. Telecommuting options are available within the U.S.