Remote Outpatient Coding Compliance Auditor

UnitedHealthcare At Home; United States; Remote; USD 73,000 - 130,000; Full time

Job summary

UnitedHealth Group is seeking an Outpatient Coding Compliance Auditor to perform audits of outpatient facility coding (OPPS) to ensure accurate ICD-10-CM, CPT/HCPCS, modifiers, and E/M levels. The role analyzes documentation, identifies trends, and communicates findings to stakeholders. Remote work from anywhere in the U.S.

is supported. The role requires CPC/CCS/COC certification and 5+ years of outpatient facility coding and audit experience, with Medicare OPPS knowledge.

Qualifications

• CPC or CCS or COC certification required.
• 5+ years outpatient facility coding experience with ICD-10-CM and CPT.
• 5+ years outpatient facility audit experience including surgery, observation and ED.
• Strong knowledge of Medicare OPPS and OCE edits.

Responsibilities

• Perform coding compliance and quality audits supporting Optum Insight Provider's Compliance Program.
• Independently analyze and interpret clinical documentation from medical records.
• Validate coding accuracy for outpatient facility, including E/M services, procedures and modifiers.
• Identify audit findings, calculate billing error rates, and perform root cause analysis.

Skills

Auditing

Coding compliance

Communication

Time management

Education

CPC/CCS/COC certification

RHIA/RHIT/CPMA (preferred)

Tools

Microsoft Excel

Teams

PowerPoint

Word

Outlook

Job description

UnitedHealth Group is seeking an Outpatient Coding Compliance Auditor to perform audits of outpatient facility coding (OPPS) to ensure accurate ICD-10-CM, CPT/HCPCS, modifiers, and E/M levels. The role analyzes documentation, identifies trends, and communicates findings to stakeholders. Remote work from anywhere in the U.S.

is supported. The role requires CPC/CCS/COC certification and 5+ years of outpatient facility coding and audit experience, with Medicare OPPS knowledge.