Billing Compliance Auditor – National Remote

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 diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

 

This position is full time Monday – Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 6:00 am – 6:00 pm EST. It may be necessary, given the business need, to work occasional overtime.

 

We offer 12 weeks of on-the-job training. The hours of the training will be aligned with your schedule.

 

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

 

PRIMARY RESPONSIBILITIES:

• Responsible for performing internal coding audits and billing compliance reviews of various elements of physician billing for the organization.  
• Works within specified third party payer and federal (CMS) coding/billing regulations.
• Develops training and education materials.  
• Provides training and education to providers, clinical department and Revenue Operations staff.
• Provides other internal billing-related compliance services to the organization as required.
• Measures coding trends as compared to national standards. 
• Review work samples from applicable reps/analysts to ensure quality/accuracy (e.g., billing processors, quality reps, collection reps).
• Demonstrate understanding of applicable quality review processes (e.g., corporate reviews, individual reviews, focus reviews, review to outcome analysis).
• Communicate audit/review findings to applicable stakeholders, as needed (e.g., Billing Operations, Customer Care, Optum).
• Respond to inquiries from applicable stakeholders (e.g., Quality groups, Billing Operations, Customer Care, vendors), and escalate as needed and take appropriate action.
• Review and ensure accuracy of audit reports prior to distribution to upper management.
• Provide support for external audit requests, as needed (e.g. Performant).

 

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
• 18 years or older
• Certified Professional Coder required (one of the following: CPC, CCS, CPMA, CEMC or COC).
• 3+ years of experience in a physician/professional billing environment.
• Experience with auditing physician chart utilizing E+M guidelines.
• Provider education/Presentation Skills.
• Utilize standard scoring (CMS) methodologies to report findings to providers.
• Ability to employ clinical reference with the auditing process.
• Apply CPT and ICD-10 coding convention to documentation guidelines.
• Apply CMS and other payer constraints to final code and documentation determination.
• Knowledge of medical terminology
• Experience with Microsoft Office Suite (Microsoft Excel, Microsoft Word, Microsoft Power Point) or successful completion of related course.
• Must show proficiency in current billing software (EPIC) within six (6) months.
• Ability to work any of our 8-hour shift schedules during our normal business hours of 6:00 am – 6:00 pm EST. It may be necessary, given the business need, to work occasional overtime.

 

 

Preferred Qualifications:

• Great communication
• Able to work independently and within a team
• Demonstrated experience with third party payer guidelines.

 

Telecommuting Requirements:

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

  

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy  

 

The hourly range for this role is $23.70 to $46.35 per hour based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. 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.

 

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.

 

 

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity / Affirmative Action employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

 

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

 

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