Risk Adjustment Validation Auditor

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.

The Risk Adjustment Validation Auditor provides auditing services that measures the accuracy and completeness of medical records by performing chart reviews that include analysis of ICD-10-CM codes reported for clinical diagnoses, injuries, illnesses, or medical procedures, including but not limited to targeted quality assurance audits of diagnosis codes 

In addition, the Risk Adjustment Validation Auditor serves as a subject matter expert in ICD-10-CM coding and documentation guidelines, V24 and V28 risk adjustment models, and the RADV audit process ensuring that valid Hierarchal Coding Conditions are being presented to our clients and to CMS.

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

Primary Responsibilities:

• Reviews codes audited by the QA Team for accuracy and completeness
• Ability to decipher and apply best practices
• Supports production and outside audit volume as the business requires
• Successfully implements new processes
• Identifies and communicates trending inaccuracies and/or missed opportunities
• Participates in team meetings/discussions of quality trends reported by team members
• Analyzes areas of need and collaborates with team to develop best practices
• Provide guidance on the communication of errors to coders
• Identifies QA processes that impede quality
• Propose quality initiatives that will impact Auditor quality
• Adheres to the schedule and communicates any changes to the team supervisor
• Understands and complies with policies and procedures for the confidentiality of all audit results, patient records, HIPAA, and system security

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)
• Professional coder certification with credentialing from AHIMA and/or AAPC (CCA, CCS, RHIA, RHIT, CPC-H/COC, CIC, CCS-P, CPC, and CPC-A) to be maintained annually
• 5+ years of HCC coding experience in utilizing inpatient and outpatient coding guidelines
• Intermediate level of knowledge in risk adjustment V24 and V28 models
• Intermediate level of proficiency in MS Office (Excel, PowerPoint, and Word)

Preferred Qualifications: 

• Prior RAD-V experience
• Certification of CRC
• Inpatient and Outpatient Coding experience
• Knowledge of Risk Adjustment Data Validation (RADV) Coding Guidelines
• Ability to assimilate and adapt quickly and accurately
• Close attention to detail, strong grammar and reading comprehension skills
• Strong critical thinking and problem-solving skills.
• Excellent organizational ability to manage multiple projects and perform in a deadline driven environment
• Ability to maintain professionalism and a positive service attitude at all times

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 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 $23.41 to $41.83 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