Remote Medical Coding Auditor - Claims Integrity

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

Benefits offered by this job

Telecommuter policy

Benefits package

Job summary

Optum is seeking a Medical Coding Auditor to determine claim accuracy by comparing provider records with CPT/HCPCS coding. You will assess coding precision, ensure compliance, and provide detailed narratives. Candidates must demonstrate coder certifications and solid medical record review experience.

This telecommuting role requires strong independent judgment, excellent written communication, and the ability to manage a production-driven workflow while collaborating with cross-functional teams.

Qualifications

• AHIMA/ AAPC certified coder with 2+ years experience.
• 2+ years CPT/HCPCS/modifier coding experience.
• 2+ years medical record review experience.
• 1+ year in a metric-driven team with daily production standards.

Responsibilities

• Performs clinical review of CPT, HCPCS, and modifiers assigned to codes on claims.
• Determines accuracy of medical coding/billing and payment recommendation for claims.
• Consults with Medical Director/physician and interprets applicable policies.
• Determines appropriate level of service using E/M coding principles.
• Provides detailed clinical narratives on case outcomes.
• Ensures adherence to state and federal compliance policies.
• Identifies aberrant billing patterns and potential fraud indicators.
• Manages daily case review assignments with quality and productivity standards.
• Provides clinical support to other investigative areas.
• Participates in team and department meetings.
• Works independently when applicable.
• Serves as a clinical resource to other areas within the team.

Skills

AHIMA/AAPC coder

Medical record review

Team collaboration

Data interpretation

Documentation skills

Education

AHIMA CCS

AAPC CPC

Tools

COSMOS

Facets

CPW

NICE

ISET

UNET

Job description

Optum is seeking a Medical Coding Auditor to determine claim accuracy by comparing provider records with CPT/HCPCS coding. You will assess coding precision, ensure compliance, and provide detailed narratives. Candidates must demonstrate coder certifications and solid medical record review experience.

This telecommuting role requires strong independent judgment, excellent written communication, and the ability to manage a production-driven workflow while collaborating with cross-functional teams.