Remote Medical Coding Auditor – Claims & Compliance

Texas Health Institute; Plymouth, Northern (MN, KY); Hybrid; USD 68,770,000 - 123,213,000; Full time

Benefits offered by this job

Benefits package

Telecommuting

Job summary

UnitedHealth Group is seeking a Medical Coding Auditor to verify CPT/HCPCS coding accuracy and review medical records remotely from anywhere in the United States. You will analyze claims, determine service levels, and draft detailed narratives while ensuring compliance with policies and regulatory guidelines.

The role requires AHIMA or AAPC credentials with 2+ years of coding and chart review experience and a track record in waste & abuse investigations.

Qualifications

• Certified coder with AHIMA or AAPC credentials.
• 2+ years medical coding and chart review experience.
• Experience in a metric-driven, team environment.
• Knowledge of waste and abuse principles.

Responsibilities

• Performs clinical review of CPT, HCPCS, and modifiers on claims in a telecommuting work environment.
• Determines accuracy of medical coding/billing and payment recommendations.
• Provides detailed clinical narratives on case outcomes.
• Ensures adherence to state and federal compliance policies and contracts.
• Identifies aberrant billing patterns and advises on reviews.

Skills

AHIMA Coder

AAPC Coder

CPT/HCPCS coding

Medical record review

Team environment

Regulatory knowledge

Education

AHIMA/AAPC certification

Tools

COSMOS

Facets

CPW

NICE

UNET

Job description

UnitedHealth Group is seeking a Medical Coding Auditor to verify CPT/HCPCS coding accuracy and review medical records remotely from anywhere in the United States. You will analyze claims, determine service levels, and draft detailed narratives while ensuring compliance with policies and regulatory guidelines.

The role requires AHIMA or AAPC credentials with 2+ years of coding and chart review experience and a track record in waste & abuse investigations.