Remote Medical Coding Auditor - Impactful Data Reviews

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

Job summary

Optum is hiring a Medical Coding Auditor to verify claims against medical records and ensure compliance with coding guidelines. This telecommuting role allows you to work from anywhere in the United States while contributing to accurate payer decisions and reducing waste in health care.

Responsibilities include CPT/HCPCS coding reviews, narrative case documentation, and collaboration with providers and internal teams to maintain quality and production metrics in a remote, production-driven

Qualifications

• Certified Coder AHIMA (CCA, CCS, CCS-P) or AAPC CPC/CPC-I
• 2+ years as an AHIMA or AAPC Certified coder
• 2+ years of CPT/HCPCS/modifier coding experience
• 2+ years strong medical record review experience
• 1+ year in a metric-driven team with daily production and quality standards

Responsibilities

• Performs clinical review of CPT, HCPCS, and modifiers on claims in a telecommuting environment
• Determines accuracy of medical coding/billing and payment recommendations
• Interprets state/federal mandates, applicable benefit language, and policies
• Determines appropriate level of service using Evaluation and Management principles
• Provides detailed clinical narratives on case outcomes
• Ensures adherence to compliance and contract policies
• Identifies aberrant billing patterns and potential fraud, waste, or abuse
• Manages daily case review assignments with quality and productivity
• Provides clinical support to investigative and analytical areas
• Participates in team and department meetings
• Works independently when applicable
• Serves as a clinical resource within the team
• Works with partners to obtain additional information for clinical reviews

Skills

AHIMA/AAPC certified coder

2+ years coding experience

2+ years medical record review

Metric-driven environment experience

Job description

Optum is hiring a Medical Coding Auditor to verify claims against medical records and ensure compliance with coding guidelines. This telecommuting role allows you to work from anywhere in the United States while contributing to accurate payer decisions and reducing waste in health care.

Responsibilities include CPT/HCPCS coding reviews, narrative case documentation, and collaboration with providers and internal teams to maintain quality and production metrics in a remote, production-driven