Remote M&R Coding Clinical Analyst - Health Claims Expert

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

Benefits offered by this job

Benefits package

Remote work

Job summary

UnitedHealth Group is seeking a detail-oriented M&R Coding Clinical Analyst to verify the accuracy of provider-submitted claims by comparing them to medical records for specific dates of service. This role requires independent judgment on complex payment decisions while ensuring compliance with state and federal guidelines.

Remote work is available nationwide within the U.S. The position emphasizes data interpretation, communication with providers, and adherence to production and quality

Qualifications

• High School Diploma or equivalent required.
• CPC/CCS/CS-P or RN/LPN with active license and coding experience preferred.
• 2+ years of AHIMA or AAPC coding certification experience with CPT/HCPCS/ICD coding.
• 2+ years of health insurance terminology and regulatory guidelines experience.
• Proficient computer skills and ability to navigate multiple systems.

Responsibilities

• Perform quality audits of clinical review cases for CPT, HCPCS, and modifiers in a telecommuting environment.
• Determine accuracy of medical coding and payment recommendations for pre-payment claims.
• Consultation with Medical Director/physician on applicable mandates and policies.
• Determine appropriate level of service using Evaluation and Management coding principles.
• Maintain compliance with state/federal policies and contract requirements.
• Identify aberrant billing patterns and potential fraud indicators and flag providers for review.
• Manage daily case reviews with metrics for quality, utilization, and productivity.

Skills

AHIMA/AAPC CPC

CPT/HCPCS coding

Medical record auditing

Healthcare terminology

Microsoft Office

Education

High School Diploma

Bachelor's degree

Job description

UnitedHealth Group is seeking a detail-oriented M&R Coding Clinical Analyst to verify the accuracy of provider-submitted claims by comparing them to medical records for specific dates of service. This role requires independent judgment on complex payment decisions while ensuring compliance with state and federal guidelines.

Remote work is available nationwide within the U.S. The position emphasizes data interpretation, communication with providers, and adherence to production and quality