Remote M&R & Clinical Coding Investigator

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

Job summary

Optum is seeking a Senior Recovery Resolution Analyst within the M&R Coding Clinical team to review claims for accuracy against medical records, ensuring compliance with state and federal guidelines. This role requires independent decision-making, strong data interpretation, and clear written communication with providers.

You’ll manage a caseload under strict productivity and quality standards, contributing to fraud prevention and payment integrity initiatives.

Qualifications

• AHIMA or AAPC CPC/CCS/CCS-P certification or active nursing license with medical record auditing experience.
• 2+ years of AHIMA/AAPC coding experience with CPT/HCPCS/ICD/Modifiers -10/CM/PCS.
• 2+ years of health insurance industry knowledge and regulatory guidelines.
• 1+ years in a team-based, metric-driven environment.

Responsibilities

• Performs quality audits of clinical review cases for CPT, HCPCS, and modifiers on claims in a telecommuting environment.
• Determines accuracy of medical coding/billing and payment recommendations for pre-payment claims.
• Consults with Medical Directors/physicians and references state/federal mandates and policies.
• Determines appropriate level of service using Evaluation and Management coding principles.
• Adheres to state/federal compliance and contract policies; identifies aberrant billing patterns.

Skills

AHIMA/AAPC Coder Certification

CPT/HCPCS/ICD coding

Healthcare claims experience

Team collaboration

Nursing background

Education

High School Diploma/GED

Bachelor's degree (preferred)

Tools

Microsoft Outlook

PowerPoint

Word

Excel

Job description

Optum is seeking a Senior Recovery Resolution Analyst within the M&R Coding Clinical team to review claims for accuracy against medical records, ensuring compliance with state and federal guidelines. This role requires independent decision-making, strong data interpretation, and clear written communication with providers.

You’ll manage a caseload under strict productivity and quality standards, contributing to fraud prevention and payment integrity initiatives.