Remote Outpatient Coding Compliance Auditor

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

Benefits offered by this job

Comprehensive benefits

Incentive programs

Equity stock plan

401k match

Job summary

UnitedHealth Group is seeking an Outpatient Coding Compliance Auditor to perform audits of outpatient facility coding (OPPS) and ensure accuracy of ICD-10-CM/ CPT codes, modifiers, and E/M levels. You will review documentation, identify non-compliance drivers, and communicate findings to stakeholders.

The role supports the Compliance Program and QA oversight, with remote work flexibility within the United States. 5+ years of outpatient facility coding and auditing experience are preferred.

Qualifications

• Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) or Certified Outpatient Coder (COC).
• 5+ years of Outpatient Facility coding experience including audits.
• Knowledge of ICD-10-CM and CPT coding.
• Experience with NCCI/OCE edits and AED matrix guidelines.
• Strong understanding of Medicare OPPS and facility E/M guidelines.

Responsibilities

• Perform coding compliance and quality audits for outpatient facility (OPPS).
• Analyze and interpret clinical documentation from medical records.
• Validate coding accuracy for outpatient services, including E/M, procedures, and modifiers.
• Identify audit findings, calculate billing error rates, and perform root cause analysis.
• Prepare written audit analyses and summaries with recommendations.
• Provide QA oversight of coding audits and monitor industry regulatory updates.
• Audit vendor coders and offshore staff as needed.
• Communicate findings clearly to stakeholders.

Skills

CPC/CCS/COC

Outpatient coding

Medicare policies

Audit & QA

ICD-10-CM CPT

Education

RHIA/RHIT/CPMA a plus

Tools

Excel

Teams

PowerPoint

Word

Outlook

Job description

UnitedHealth Group is seeking an Outpatient Coding Compliance Auditor to perform audits of outpatient facility coding (OPPS) and ensure accuracy of ICD-10-CM/ CPT codes, modifiers, and E/M levels. You will review documentation, identify non-compliance drivers, and communicate findings to stakeholders.

The role supports the Compliance Program and QA oversight, with remote work flexibility within the United States. 5+ years of outpatient facility coding and auditing experience are preferred.