Remote Senior Recovery Coding Review Specialist

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

Job summary

UnitedHealth Group is seeking a Senior Recovery Resolution Analyst to validate claims against medical records and ensure coding accuracy. The role requires judgment on complex pay-ment decisions in compliance with guidelines and policies, with daily data interpretation and clear written communication to providers.

You will handle post-payment reviews, manage a demanding caseload, and work across multiple systems in a remote environment.

Qualifications

• High School Diploma or GED required.
• Certified Coder AHIMA or AAPC CPC/CCS/CCS-P/RHIT/RHIA/CDIP preferred.
• 2+ years of coding experience with medical record auditing and coding/billing experience.
• 1+ year in a metric-driven team environment with daily production and quality standards.
• Intermediate level of medical record review experience.
• Intermediate knowledge of health insurance terminology and regulatory guidelines.
• Intermediate experience with Microsoft & Adobe applications.

Responsibilities

• Performs quality audits of clinical review cases for CPT, HCPCS, and modifiers in a telecommuting environment.
• Determines accuracy of medical coding/billing and payment recommendations for post-payment claims.
• Consults with Medical Directors/physicians and interprets mandates, policies and clinical information.
• Determines appropriate level of service using E/M coding principles.
• Ensures adherence to state/federal compliance and contract policies.
• Identifies aberrant billing patterns and flags for review when needed.
• Manages daily case review assignments with quality, utilization and productivity goals.
• Provides clinical support to investigative and analytical teams.

Skills

Medical coding

Data interpretation

Communication

Teamwork

Education

High School Diploma or GED

Bachelor degree

Tools

Microsoft Office

Adobe Acrobat

Job description

UnitedHealth Group is seeking a Senior Recovery Resolution Analyst to validate claims against medical records and ensure coding accuracy. The role requires judgment on complex pay-ment decisions in compliance with guidelines and policies, with daily data interpretation and clear written communication to providers.

You will handle post-payment reviews, manage a demanding caseload, and work across multiple systems in a remote environment.