Remote Prepay Coding Investigator (CPT/Audit)

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

Benefits offered by this job

Telecommuting

Job summary

Optum is seeking a Special Investigations Unit Pre Pay Coding Consultant to investigate and resolve healthcare fraud and coding issues. This role provides coding guidance on CPT codes, mentors others, and supports internal and client projects.

You’ll work from anywhere in the U.S. with telecommuting flexibility, participate in regulatory meetings, and ensure timely claim reviews while meeting performance targets. Strong CPT coding experience and communication skills are essential.

Qualifications

• High School Diploma/GED required.
• CPC or AHIMA credentials (CCS/RHIT/RHIA) required.
• 3+ years CPT coding experience; recent auditing experience.
• Proficiency with PC-based software.
• Ability to work 8:00am-5:00pm, Monday-Friday; overtime/weekends as needed.
• 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.
• Performs additional projects as needed by the business or client; analyzes data; coordinates with stakeholders.
• Continuous monitoring of claim inventory to adhere to performance guarantees.

Education

High School Diploma/GED

Strong CPT coding experience

Communication skills

Teamwork

Time management

Multitasking

Tools

PC-based software

Job description

Optum is seeking a Special Investigations Unit Pre Pay Coding Consultant to investigate and resolve healthcare fraud and coding issues. This role provides coding guidance on CPT codes, mentors others, and supports internal and client projects.

You’ll work from anywhere in the U.S. with telecommuting flexibility, participate in regulatory meetings, and ensure timely claim reviews while meeting performance targets. Strong CPT coding experience and communication skills are essential.