Remote M&R Coding Investigator - Claims Audit

University of Minnesota School of Nursing; Plymouth (MN); Hybrid; USD 33,000 - 59,000; Full time

Job summary

UnitedHealth Group is seeking a M&R Coding Clinical Analyst to review medical records and determine coding accuracy for pre-payment claims. This remote role requires coding credentials and healthcare industry experience.

The candidate will analyze CPT/HCPCS/ICD coding, ensure compliance with state and federal guidelines, and collaborate with teams to support reliable payment decisions. Telecommuting is available nationwide.

Qualifications

• High School Diploma or GED required.
• AHIMA/CPC certification or active nursing license with medical record auditing experience.
• 2+ years of AHIMA/AAPC coding experience and CPT/HCPCS/ICD knowledge.
• 2+ years in health insurance industry terminology and regulatory guidelines.
• 1+ year in a metric-driven team environment with daily production standards.
• Intermediate medical record review experience and computer skills.
• Proficiency with Microsoft and Adobe applications.

Responsibilities

• Performs quality audits of clinical review cases for CPT, HCPCS, and modifiers assigned to codes on claims in a telecommuting work environment.
• Determines accuracy of medical coding/billing and payment recommendation for pre-payment claims.
• This could include Medical Director/physician consultations, interpretation of state and federal mandates, applicable benefit language, medical and reimbursement policies and consideration of relevant clinical information.
• Determines appropriate level of service utilizing Evaluation and Management coding principles.
• Ensures adherence to state and federal compliance policies, reimbursement policies and contract compliance.
• Identifies aberrant billing patterns and trends, evidence of fraud, waste or abuse, and recommends providers to be flagged for review.
• Maintains and manages daily case review assignments, with accountability to quality, utilization and productivity standards.
• Provides clinical support and expertise to the other investigative and analytical areas.
• Participates in team and department meetings.
• Engages in a collaborative work environment when applicable but is also able to work independently.
• Serves as a clinical resource to other areas within the clinical investigative team.
• Work with applicable business partners to obtain additional information relevant to the clinical review.

Skills

AHIMA/CPC certified coder

RN/LPN license

Medical record auditing

CPT/HCPCS/ICD coding

Health insurance terminology

Team-based work

MS Office proficiency

Education

High School Diploma or GED

Bachelor's degree

Tools

MS Office

Adobe Acrobat

Job description

UnitedHealth Group is seeking a M&R Coding Clinical Analyst to review medical records and determine coding accuracy for pre-payment claims. This remote role requires coding credentials and healthcare industry experience.

The candidate will analyze CPT/HCPCS/ICD coding, ensure compliance with state and federal guidelines, and collaborate with teams to support reliable payment decisions. Telecommuting is available nationwide.