Remote Medical Coding Compliance Auditor

UnitedHealth Group; Eden Prairie (MN); Remote; USD 60,000 - 107,000; Full time

Benefits offered by this job

Comprehensive benefits

Incentive programs

Equity stock purchase

401k contribution

Job summary

UnitedHealth Group is seeking a senior coding compliance auditor to independently perform risk-based audits of providers and clinical practices, ensuring CPT/HCPCS/ICD-10 accuracy and CMS compliance. You will analyze investigations, identify risk areas, and prepare detailed reports with remediation actions.

The role supports ongoing education based on audit findings, stays current with coding guidelines, and allows telecommuting within the U.S.

Qualifications

• High School Diploma or GED.
• Certified Professional Coder (CPC), Certified Outpatient Coder (COC), Certified Coding Specialist (CCS), or CCS-P.
• 5+ years of outpatient physician coding experience, including CPT, HCPCS, ICD-10, modifiers, and NCCI edits.
• 5+ years of healthcare regulatory compliance experience, including Medicare, Medicaid, and state and federal laws and regulations.
• 3+ years of experience with electronic health records (EHRs) and medical record systems.
• Advanced level of proficiency with Microsoft Excel, Teams, PowerPoint, Word, and Outlook.

Responsibilities

• Conduct independent, risk-based coding compliance audits of Optum Health providers and associated clinical practices.
• Conduct coding and billing investigation audits to assess compliance with applicable coding, billing, and documentation requirements.
• Research and analyze incoming coding and billing investigation requests to support timely and accurate compliance review.
• Evaluate the accuracy, completeness, and regulatory compliance of procedure coding, including E/M services, non-E/M services, modifiers, ICD-10 coding, medical record documentation, and coding-related billing activities.
• Identify areas of compliance risk, assess adherence to CMS requirements, official coding guidelines, payer policies, and organizational standards, and support corrective action and monitoring activities.
• Prepare written audit scope memorandums that clearly define audit objectives, methodology, and review criteria.
• Identify audit findings, calculate billing error rates, and perform root cause analysis to support accurate reporting and remediation planning.
• Prepare written audit summary reports that include compliance risks, trends, findings, and recommended remediation actions.
• Research, develop, and deliver targeted education based on individual audit findings.
• Stay current with applicable coding, billing, documentation, and regulatory guidelines.
• Research, evaluate, and provide timely responses to coding compliance inquiries, ensuring alignment with applicable coding, billing, and regulatory guidance.

Skills

Outpatient coding experience

Regulatory compliance experience

Advanced Excel

Communication skills

Education

CPC

COC

CCS

CCS-P

Tools

Microsoft Excel

Microsoft Teams

PowerPoint

Word

Outlook

EHR systems

Job description

UnitedHealth Group is seeking a senior coding compliance auditor to independently perform risk-based audits of providers and clinical practices, ensuring CPT/HCPCS/ICD-10 accuracy and CMS compliance. You will analyze investigations, identify risk areas, and prepare detailed reports with remediation actions.

The role supports ongoing education based on audit findings, stays current with coding guidelines, and allows telecommuting within the U.S.