Special Investigations Unit Pre Pay Coding Consultant

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

Benefits offered by this job

Comprehensive benefits

Equity stock purchase

401(k) plan

Job summary

UnitedHealth Group is seeking a Coding Consultant to investigate and resolve healthcare fraud and provider abuse using CPT coding guidance. You will mentor investigators, review claims against medical records, and coordinate with internal and external stakeholders to ensure compliant, accurate coding.

The role supports telecommuting from anywhere in the United States, with strong benefits, recognition programs, and opportunities for professional growth.

Qualifications

• High School Diploma or GED required.
• CPC or CCS/AHIMA certification preferred.
• 3+ years CPT coding experience required.
• Recent coding/auditing experience within 1–2 years.
• Proficiency with PC-based software.

Responsibilities

• Review prepay claims with medical records to determine payment accuracy (70%).
• Review policies, CPT guidelines and contracts relevant to clinical review (10%).
• Participate in regulatory meetings with clients (5%).
• Assist with provider-related issues and coordination with providers, advocates and legal (5%).
• Handle additional projects, analyze data, and coordinate with stakeholders (5%).
• Monitor claim inventory to ensure performance guarantees.

Skills

CPT coding expertise

Healthcare fraud investigation

Mentoring others

Stakeholder collaboration

Education

High School Diploma or GED

Certified Coder (AAPC CPC) or CCS/AHIMA RHIT/RHIA

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