Remote Prepay Coding Investigator (CPT Audits)

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

Benefits offered by this job

Telecommuting allowed

Comprehensive benefits package

Equity stock purchase

401k contribution

Job summary

Optum, part of UnitedHealth Group, is seeking a Coding Consultant to investigate healthcare fraud and assist with medical coding reviews. You will mentor others and support internal/external projects while ensuring regulatory compliance.

Work flexibility allows telecommuting from anywhere in the U.S.; the role requires CPT coding expertise, CPC/CCS credentials, and a strong focus on accuracy and collaboration with investigators and providers in Minnesota.

Qualifications

• High School Diploma or GED required.
• Certified coder with CPC or CCS/RHIT/RHIA credentials.
• 3+ years of CPT coding experience.
• Recent coding/auditing experience within the last 1-2 years.
• Proficient with PC based software.
• Must be able to work 8:00am–5:00pm Monday–Friday; overtime may be required.

Responsibilities

• Reviews prepay claims with medical records to determine payment accuracy.
• Reviews applicable policies, CPT guidelines and contracts.
• Participates in regulatory meetings with the client.
• Participates in meetings with providers, advocates and legal teams.
• Performs additional projects as needed and analyzes data for resolution.
• Continuous monitoring of claim inventory to meet performance guarantees.

Skills

CPT coding

Auditing experience

CPC credential

Healthcare billing

PC software

Education

High School Diploma or GED

AAPC/CPC or AHIMA credentials

Tools

Coding software

Job description

Optum, part of UnitedHealth Group, is seeking a Coding Consultant to investigate healthcare fraud and assist with medical coding reviews. You will mentor others and support internal/external projects while ensuring regulatory compliance.

Work flexibility allows telecommuting from anywhere in the U.S.; the role requires CPT coding expertise, CPC/CCS credentials, and a strong focus on accuracy and collaboration with investigators and providers in Minnesota.