Remote Outpatient Coding Compliance Auditor

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

Job summary

UnitedHealth Group is seeking an Outpatient Coding Compliance Auditor to conduct audits of OPPS coding, ensuring accurate ICD-10-CM and CPT coding, modifiers, and E/M levels. The role monitors QA processes and communicates findings to stakeholders while aligning with applicable laws and regulations.

You will analyze medical records, identify root causes of non-compliance, and support education based on audit results. Remote work within the U.S. is possible.

Qualifications

• 5+ years of Outpatient Facility coding experience including NCCI/OCE billing edits.
• ICD-10-CM and CPT coding knowledge including CPT-4.
• Familiarity with ACEP Facility or similar Facility E/M matrix guidelines.
• 5+ years of outpatient facility audit experience, including surgery, observation, and ED, with Medicare knowledge.

Responsibilities

• Perform coding compliance and quality audits to support Optum Insight Providers Compliance Program and client expectations.
• Analyze clinical documentation from medical records.
• Validate coding for outpatient facility including E/M services, procedures and modifiers.
• Identify audit findings, calculate error rates, perform root cause analysis.

Skills

Outpatient coding

ICD-10-CM/CPT coding

ACEP/E/M guidelines

Auditing

Education

CPC/CCS/COC certification

RHIA/RHIT/CPMA (preferred)

Tools

Microsoft Excel

Microsoft Teams

PowerPoint

Word

Outlook

Job description

UnitedHealth Group is seeking an Outpatient Coding Compliance Auditor to conduct audits of OPPS coding, ensuring accurate ICD-10-CM and CPT coding, modifiers, and E/M levels. The role monitors QA processes and communicates findings to stakeholders while aligning with applicable laws and regulations.

You will analyze medical records, identify root causes of non-compliance, and support education based on audit results. Remote work within the U.S. is possible.