Remote Prepay Coding & Fraud Investigator

DaMar Staffing; United States; Remote; USD 68,770,000 - 123,213,000; Full time

Benefits offered by this job

Telecommute

Job summary

UnitedHealth Group is seeking a Coding Consultant to investigate healthcare fraud and abuse, reviewing CPT codes, medical records, and related documentation. The role supports internal and external stakeholders and provides guidance on CPT coding during investigations.

The position offers telecommuting within the United States, requires CPC/CCS/RHIT/RHIA credentials and several years of CPT coding experience, with a focus on accuracy and regulatory compliance.

Qualifications

• High School Diploma or GED required.
• CPC or AHIMA credentials (CPC, CCS, RHIT, RHIA) preferred.
• 3+ years CPT coding experience.
• Recent coding/auditing experience (1–2 years).
• Proficient with PC-based software.

Responsibilities

• Reviews prepay claims with medical records to determine payment accuracy (85%).
• Reviews policies, CPT guidelines and contracts related to clinical review (10%).
• Monitors claim inventory to meet performance guarantees (5%).

Skills

CPT coding

CPC certification

AHIMA CCS

Medical records review

Team collaboration

Education

High School Diploma

Tools

PC software

Job description

UnitedHealth Group is seeking a Coding Consultant to investigate healthcare fraud and abuse, reviewing CPT codes, medical records, and related documentation. The role supports internal and external stakeholders and provides guidance on CPT coding during investigations.

The position offers telecommuting within the United States, requires CPC/CCS/RHIT/RHIA credentials and several years of CPT coding experience, with a focus on accuracy and regulatory compliance.