Remote Prepay Coding Investigator (CPC/CCS)

Optum; Plymouth (MN); On-site; USD 33,000 - 59,000; Full time

Job summary

Optum is seeking a Coding Consultant to investigate and resolve healthcare fraud and abuse by coding guidance on CPT codes and mentoring investigators. This role involves reviewing claims, records, and policies, with remote work flexibility across the U.S.

You will interact with clients, providers, and legal teams and support multiple projects while meeting regulatory requirements. Candidates should have CPC or AHIMA credentials, 3+ years CPT coding, and strong PC software skills.

Qualifications

• High School Diploma/GED.
• CPC or CCS/RHIT/RHIA credentials.
• 3+ years of CPT coding experience.
• Recent professional coding/auditing experience within the last 1-2 years.
• Intermediate proficiency with PC-based software.
• Ability to work 8:00am–5:00pm, Mon–Fri; overtime or weekends may be required.
• Must be 18 years of age or older.

Responsibilities

• Reviews prepay claims with corresponding medical records to determine payment accuracy.
• Reviews applicable policies, CPT guidelines and contracts as they pertain to clinical review.
• Participates in regulatory meetings with the client.
• Participates in meetings with providers, advocates and legal to assist with provider abrasion.
• G Performs additional projects as needed by the business or Client; analyzes data; meets with internal and external stakeholders as necessary for resolution.
• Continuous monitoring of claim inventory to adhere to performance guarantees.

Skills

CPT coding experience

Auditing experience

Teamwork

Communication skills

Health insurance coding

PC software proficiency

Education

High School Diploma/GED

CPC or CCS/RHIT/RHIA credentials

Tools

PC-based software

Job description

Optum is seeking a Coding Consultant to investigate and resolve healthcare fraud and abuse by coding guidance on CPT codes and mentoring investigators. This role involves reviewing claims, records, and policies, with remote work flexibility across the U.S.

You will interact with clients, providers, and legal teams and support multiple projects while meeting regulatory requirements. Candidates should have CPC or AHIMA credentials, 3+ years CPT coding, and strong PC software skills.