Remote Prepay Coding Investigator

Texas Health Institute; Plymouth, Northern (MN, KY); Hybrid; USD 68,770,000 - 123,213,000; Full time

Benefits offered by this job

Comprehensive benefits package

Incentive and recognition programs

Equity stock purchase opportunities

401k contribution

Job summary

Optum, a leader in health care technology and services, seeks a Coding Consultant to investigate and resolve healthcare fraud and coding issues. The role uses CPT guidance to support investigations, mentor teammates, and collaborate with internal and external stakeholders across projects.

You’ll work from anywhere in the U.S. with flexible telecommuting, aiming to meet targets and regulatory requirements while contributing to client success and care equity.

Qualifications

• High School Diploma or GED.
• Certified coder with AAPC CPC or AHIMA CCS/RHIT/RHIA.
• 3+ years CPT coding experience.
• Recent coding/auditing experience within the last 1-2 years.
• Proficiency with PC-based software.
• Ability to work standard business hours 8:00am–5:00pm, Monday–Friday; overtime/weekends possible.
• Must be 18 years or older.

Responsibilities

• Reviews prepay claims with medical records to determine payment accuracy (70%).
• Reviews policies, CPT guidelines and contracts relevant to clinical review.
• Participates in regulatory meetings with the client.
• Participates in meetings with providers, advocates and legal to assist with provider abrasion.
• Performs additional projects; analyzes data; engages stakeholders for resolution.
• Monitors claim inventory to meet performance guarantees.

Skills

CPT coding

AAPC CPC

AHIMA CCS

RHIT

RHIA

PC skills

Education

High School Diploma/GED

Tools

PC-based software

Job description

Optum, a leader in health care technology and services, seeks a Coding Consultant to investigate and resolve healthcare fraud and coding issues. The role uses CPT guidance to support investigations, mentor teammates, and collaborate with internal and external stakeholders across projects.

You’ll work from anywhere in the U.S. with flexible telecommuting, aiming to meet targets and regulatory requirements while contributing to client success and care equity.