Remote Medical Coding Auditor — Claims Integrity & Compliance

DaMar Staffing; Minneapolis (MN); On-site; USD 68,770,000 - 123,213,000; Full time

Benefits offered by this job

Comprehensive benefits

Equity stock purchase program

401k contribution

Telecommuter policy

Job summary

Optum, part of UnitedHealth Group, seeks a Medical Coding Auditor to verify claims against medical records in a telecommuting role. You will review CPT/HCPCS codes, determine coding accuracy, and provide narratives on outcomes while ensuring compliance with policies.

Candidates should hold AHIMA/AAPC credentials with multiple years of coding and medical record review experience. Strong communication and a team-oriented, metric-driven mindset are essential.

Qualifications

• Certified coder (AHIMA CCS/CCA/CCS-P or AAPC CPC/CPC-I) with 2+ years coding experience.
• 2+ years CPT/HCPCS/modifier coding experience.
• 2+ years medical record review experience.
• 1+ year in a metric-driven team environment with daily production and quality standards.
• 1+ year in health insurance industry using regulatory guidelines and terminology.
• 1+ year experience with Waste & Error principles.

Responsibilities

• Perform clinical review of CPT/HCPCS codes and modifiers on claims in a telecommuting environment.
• Determine accuracy of coding/billing and provide payment recommendations.
• Coordinate with physicians or medical directors for coding guidance as needed.
• Determine appropriate level of service using E/M coding principles.
• Provide detailed clinical narratives on case outcomes.
• Ensure adherence to state and federal policies, reimbursement policies and contracts.
• Identify aberrant billing patterns and potential fraud or waste and flag providers for review.
• Manage daily case review assignments with quality, utilization and productivity targets.
• Offer clinical support to other investigative and analytical areas.

Skills

Medical coding

Medical record review

Team collaboration

Health insurance knowledge

Waste & Error principles

Communication skills

Education

AHIMA/AAPC Certified coder

Tools

COSMOS

Facets

CPW

NICE

ISET

UNET

Microsoft Office

Excel

Adobe Acrobat

Outlook

Job description

Optum, part of UnitedHealth Group, seeks a Medical Coding Auditor to verify claims against medical records in a telecommuting role. You will review CPT/HCPCS codes, determine coding accuracy, and provide narratives on outcomes while ensuring compliance with policies.

Candidates should hold AHIMA/AAPC credentials with multiple years of coding and medical record review experience. Strong communication and a team-oriented, metric-driven mindset are essential.