Quality Medical Coder at UnitedHealth Group

Remote | Full-time
UnitedHealth Group

Title: Quality Medical Coder – Remote

job category: Clinical

job description:

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

Energize your career with one of Healthcare’s fastest growing companies.

You dream of a great career with a great company – where you can make an impact and help people. We dream of giving you the opportunity to do just this. And with the incredible growth of our business, it’s a dream that definitely can come true. Already one of the world’s leading Healthcare companies, UnitedHealth Group is restlessly pursuing new ways to operate our service centers, improve our service levels and help people lead healthier lives. We live for the opportunity to make a difference and right now, we are living it up.

This opportunity is with one of our most exciting business areas: Optum – a growing part of our family of companies that make UnitedHealth Group a Fortune 10 leader.

Optum helps nearly 60 million Americans live their lives to the fullest by educating them about their symptoms, conditions and treatments; helping them to navigate the system, finance their healthcare needs and stay on track with their health goals. No other business touches so many lives in such a positive way. And we do it all with every action focused on our shared values of Integrity, Compassion, Relationships, Innovation & Performance

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

Primary Responsibilities:

  • Performs Quality Audits focused on medical coding principles and guidelines, as well as operational performance and processes as needed.
  • Extract precise information from documentation, test results, and reports to audit and ensure appropriate codes were assigned.
  • Audit and test ongoing operational processes to assure continued compliance with all requirements regarding coding procedures, practices and internal processing guidelines.
  • Complete audits following Quality Auditing Policy and communicate audit findings to key stakeholders on a monthly basis.
  • Review claims to formulate a synopsis of facts and collaborate with Medical Services regarding the synopsis, and perform special audits as needed to ensure compliance.
  • Prepare monthly dashboard reports for Medical Services to utilize in making adjustments/process improvements per findings as necessary.
  • Provide detailed findings for educational opportunities in collaboration with internal stakeholders.
  • Research coding and other billing regulatory issues when needed.
  • Analyze issues where understanding situations or data, require in-depth knowledge of organizational objectives.
  • Respond to concerns and allegations and work with internal stakeholders to develop corrective action plans, as well as, follow up appropriately to issues identified.
  • Stay up to date on insurance guidelines, regulations and medical coding updates/changes through training and utilization of monthly newsletters and proactively educate departmental staff regarding changes and issues affecting physicians and coding.
  • Identify process improvements that could lead to cost savings and enhancement opportunities.
  • Maintain required certifications and training.

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 (or higher)
  • 5+ years of experience in medical billing and/or coding
  • 3+ years of coding audits and/or coding quality assurance (CPT)
  • Certified Professional Coder (CPC)
  • Experienced in developing analysis of audit findings, creating audit reports, and presenting results.
  • Expertise with NCCI (National Correct Coding Initiative) guidelines.
  • Intermediate skills in Microsoft Excel – (analyze & manipulate data)

Preferred Qualifications:

  • Bachelor’s degree (or higher)
  • 3+ years of Medical Claims processing
  • Encoder Pro familiarity

Soft Skills:

  • Ability to work on software applications systems and a willingness to learn
  • Excellent analytical skills
  • Excellent Interpersonal skills and ability to work well within a team environment
  • Excellent verbal and written communication skill
  • Thorough knowledge of anatomy and medical terminology
  • Ability to manipulate large volume of data and present results

Telecommuting Requirements:

  • Required to have a dedicated work area established that is separated from other living areas and provides information privacy
  • Ability to keep all company sensitive documents secure (if applicable)
  • Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service

UnitedHealth Group requires all new hires and employees to report their COVID-19 vaccination status.

Colorado, Connecticut or Nevada Residents Only: The salary range for Colorado residents is $20.77 to $36.88. The salary range for Connecticut / Nevada residents is $22.93 to $40.58. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives

Additional Job Detail Information

Requisition Number: 2028621

Business Segment: Optum Health Services

Employee Status: Regular

Job Level: Individual Contributor

Travel: No

Additional Locations:

  • Phoenix, AZ, US
  • Hartford, CT, US
  • Tampa, FL, US
  • Minneapolis, MN, US

Overtime Status: Non-exempt

Schedule: Full-time

Shift: Day Job

Telecommuter Position: Yes

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