Special Investigations Unit Pre Pay Coding Consultant

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

Benefits offered by this job

Comprehensive benefits package

Incentive and recognition programs

Equity stock purchase opportunities

401k contribution

Job summary

Optum, a leader in health care technology and services, seeks a Coding Consultant to investigate and resolve healthcare fraud and coding issues. The role uses CPT guidance to support investigations, mentor teammates, and collaborate with internal and external stakeholders across projects.

You’ll work from anywhere in the U.S. with flexible telecommuting, aiming to meet targets and regulatory requirements while contributing to client success and care equity.

Qualifications

• High School Diploma or GED.
• Certified coder with AAPC CPC or AHIMA CCS/RHIT/RHIA.
• 3+ years CPT coding experience.
• Recent coding/auditing experience within the last 1-2 years.
• Proficiency with PC-based software.
• Ability to work standard business hours 8:00am–5:00pm, Monday–Friday; overtime/weekends possible.
• Must be 18 years or older.

Responsibilities

• Reviews prepay claims with medical records to determine payment accuracy (70%).
• Reviews policies, CPT guidelines and contracts relevant 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; analyzes data; engages stakeholders for resolution.
• Monitors claim inventory to meet performance guarantees.

Skills

CPT coding

AAPC CPC

AHIMA CCS

RHIT

RHIA

PC skills

Education

High School Diploma/GED

Tools

PC-based software

Job description

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

High Level Overview of the Role:

Coding Consultant is responsible for investigating and resolving instances of healthcare fraud and abuse of medical providers. Coding Consultant uses information from a tip, member benefits, and medical records to document relevant findings. This position will achieve applicable targets and metrics as determined. This individual will provide mentoring, explanations, and feedback to others on difficult issues. This position assists with projects both internal and external to the team. The Coding Consultant provides coding guidance to investigators on CPT codes relevant to an investigation. This position works with minimal guidance and seeks input on the most complex of tasks. Works with internal and external stakeholders to facilitate client requests and maintains compliance with regulatory requirements.

You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

Day to Day Responsibilities: (include % of time after each main duty; total should = 100%)

• Reviews prepay claims with corresponding medical records to determine payment accuracy. (70%)
• Reviews applicable policies, CPT guidelines and contracts as they pertain to clinical review. (10%)
• Participates in regulatory meetings with the client (5%)
• Participates in meetings with providers, advocates and legal to assist with provider abrasion. (5%)
• Performs additional projects as needed by the business or Client; analyzes data; meets with internal and external stakeholders as necessary for resolution. (5%)
• Continuous monitoring of claim inventory in order to adhere to performance guarantees. (5%)

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

• High School Diploma/GED
• Certified Coder with credentials from AAPC with a CPC or AHIMA with CCS, RHIT, RHIA
• 3+ years of CPT coding experience
• Recent professional coding/auditing experience within the last 1-2 years
• Intermediate level of proficiency with PC based software
• Ability to work our normal business hours of 8:00am - 5:00pm, Monday - Friday. It may be necessary, given the business need, to work occasionally overtime or weekends
• Must be 18 years of age or older

Preferred Qualifications:

• Ability to prioritize and manage multiple tasks
• Proven ability to work in a team setting
• Excellent oral and written communication skills and presentation skills
• Experience with health insurance billing/coding

*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you’ll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $24.00 to $43.00 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

Application Deadline:

This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

#RPO #GREEN