Remote Prepay Coding Investigator (CPT)

ISHE; Plymouth, Northern (MN, KY); Hybrid; USD 33,000 - 59,000; Full time

Job summary

Optum is seeking a Coding Consultant to investigate and resolve healthcare fraud and abuse, using CPT coding knowledge to document findings and guide investigations. The role offers telecommuting from anywhere in the United States and targets 8:00am–5:00pm hours with occasional overtime.

Responsibilities include reviewing claims with medical records, ensuring payment accuracy, and collaborating with clients, providers, and legal teams.

Qualifications

• Must have CPC or CCS/RHIT/RHIA credentials.
• 3+ years CPT coding experience.
• Recent coding/auditing experience within the last 1-2 years.
• High School Diploma or GED required.

Responsibilities

• Reviews prepay claims with medical records to determine payment accuracy (70%).
• Reviews CPT guidelines and contracts related to clinical review (10%).
• Participates in regulatory meetings with the client (5%).
• Assists with provider communications and issues (5%).
• Performs additional projects and analyzes data as needed (5%).
• Monitors claim inventory to meet performance guarantees (5%).

Skills

CPT coding

Regulatory compliance

Communication

Team collaboration

Time management

Education

High School Diploma/GED

AAPC CPC

AHIMA CCS/RHIT/RHIA

Tools

PC software

Job description

Optum is seeking a Coding Consultant to investigate and resolve healthcare fraud and abuse, using CPT coding knowledge to document findings and guide investigations. The role offers telecommuting from anywhere in the United States and targets 8:00am–5:00pm hours with occasional overtime.

Responsibilities include reviewing claims with medical records, ensuring payment accuracy, and collaborating with clients, providers, and legal teams.