Remote Outpatient Coding Compliance Auditor

divvyDOSE; United States; Remote; USD 73,000 - 130,000; Full time

Benefits offered by this job

Comprehensive benefits

Equity stock purchase

401k contribution

Job summary

Optum is seeking an Outpatient Coding Compliance Auditor to perform audits of OPPS coding to ensure accurate ICD-10-CM, CPT/HCPCS, and E/M assignments. You will review documentation, identify non-compliance, and communicate findings to stakeholders.

This remote role offers flexible work options within the United States and opportunities to influence coding quality and regulatory alignment. Ideal candidates hold CPC/CCS/COC or related certification, 5+ years in outpatient facility coding and

Qualifications

• Certified Professional Coder (CPC) or CCS or COC certification.
• 5+ years of Outpatient Facility coding experience, including NCCI/OCE edits.
• Experience with ICD-10-CM and CPT coding.
• Knowledge of ACEP Facility or similar Facility E/M guidelines for outpatient coding.
• 5+ years of Outpatient Facility auditing including surgery, observation, and ED, with Medicare knowledge.

Responsibilities

• Perform coding compliance and quality audits for OPPS coding under Compliance Program and client expectations.
• Analyze and interpret clinical documentation from medical records.
• Validate coding accuracy for outpatient facility services, including E/M, procedures, and modifiers.
• Identify audit findings, calculate error rates, perform root cause analysis.
• Document audit findings clearly and tailor results to the audience.
• Prepare audit analyses and summaries including risk trends and corrective actions.
• Conduct ad hoc coding and billing audits as requested.
• Provide QA oversight of audit activities and ensure standards are followed.
• Audit vendor coders and offshore staff for quality.
• Monitor industry trends and regulatory updates affecting coding and billing.

Skills

CPC/CCS/COC

Outpatient coding

Audit experience

Education

CPC/CCS/COC certification

RHIA/RHIT/CPMA a plus

Tools

Microsoft Excel

Microsoft Teams

PowerPoint

Word

Outlook

Job description

Optum is seeking an Outpatient Coding Compliance Auditor to perform audits of OPPS coding to ensure accurate ICD-10-CM, CPT/HCPCS, and E/M assignments. You will review documentation, identify non-compliance, and communicate findings to stakeholders.

This remote role offers flexible work options within the United States and opportunities to influence coding quality and regulatory alignment. Ideal candidates hold CPC/CCS/COC or related certification, 5+ years in outpatient facility coding and