Remote Medical Claims Coding Investigator

Texas Health Institute; Plymouth (MN); Hybrid; USD 33,000 - 123,213,000; Full time

Job summary

UnitedHealth Group is seeking a M&R Coding Clinical Analyst to validate provider claims by comparing to medical records. You will interpret data, conduct pre-payment reviews, and apply coding and reimbursement policies across a telecommuting environment.

The role requires coding credentials and experience with CPT/HCPCS/ICD systems. You will work independently in a production-driven setting, collaborating with clinical teams to ensure accuracy and timely decisions.

Qualifications

• High School Diploma or GED required.
• AHIMA or AAPC coder certification (CPC/CCS/CCS-P) or active nursing license.
• 2+ years coding experience with CPT/HCPCS/ICD/Modifiers; health insurance domain knowledge.
• 2+ years in a metric-driven, team environment with production standards.
• Intermediate computer skills and ability to troubleshoot problems.

Responsibilities

• Perform quality audits of clinical review cases for CPT/HCPCS and modifiers in a telecommuting setup.
• Determine accuracy of medical coding and pre-payment payment recommendations.
• Research state and federal mandates, benefit language, and policies when reviewing cases.
• Apply E/M coding principles to determine appropriate level of service.
• Ensure compliance with state/federal policies, contracts, and reimbursement guidelines.
• Identify anomalous billing patterns and potential fraud or abuse and flag providers for review.
• Manage daily case assignments with focus on quality, utilization and productivity.
• Provide clinical support to other investigative and analytical areas and collaborate in meetings.

Skills

Intermediate computer skills

Strong communication skills

Independent and team work

Health insurance domain knowledge

Education

Bachelor's degree

High School Diploma/GED

AHIMA/AAPC coder certification or RN/LPN license

Tools

Microsoft Office

Adobe applications

Job description

UnitedHealth Group is seeking a M&R Coding Clinical Analyst to validate provider claims by comparing to medical records. You will interpret data, conduct pre-payment reviews, and apply coding and reimbursement policies across a telecommuting environment.

The role requires coding credentials and experience with CPT/HCPCS/ICD systems. You will work independently in a production-driven setting, collaborating with clinical teams to ensure accuracy and timely decisions.