Quality Assurance Coding Auditor – 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 role will provide coding quality auditing services to ensure compliance with Optum and CMS coding guidelines and accuracy of coding data reported.  Will review provider’s documentation to identify query opportunities. Must maintain compliance with Optum Coding Guidelines/policies. The minimum productivity goal is set by project, with minimum 96% coding accuracy rate required

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

Primary Responsibilities:

• Assists with execution of the daily activities of the Enterprise Quality Assurance program
• Performs first level quality audits on vendor coding results
• Identifies provider query opportunity, creates and sends compliant query to rendering provider
• Provides support and assists on various coding initiatives, such as concurrent review, query compliance audits and retrospective coding quality reviews
• Be able to work with multiple coding tools and EMR systems
• Ensure that Optum Coding Guidelines are consistently applied in all processes
• Identifies issues and trends in coding and documentation that affect coding accuracy
• Provides input and valuable feedback on audit results
• Recommends process improvement
• Perform all other related duties as assigned

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:

• Coding Certification (CPC, COC, CIC, CCS, CCS-P, or RHIT; the CPC-A or CCA designation is not acceptable)
• 4+ years of experience in ICD-10 coding, preferably in a Managed Care setting, with solid attention to detail and high accuracy rate
• 2+ years of Medicare Risk Adjustment experience (HCC coding)
• Proficient knowledge of CMS-HCC model and guidelines
• ICD-10-CM proficient
• Proven ability to work during normal business hours, Monday-Friday 8am-5pm CST (flexibility to start 8-hour shift earlier or later after successful completion of training)
• Proven ability to continuously meet the requirements for a telecommuter, i.e. live in a location that can receive a UnitedHealth Group approved high speed internet connection, have a secure designated office space to maintain PHI, meet or exceed all performance expectations

Preferred Qualifications:

• CRC (Certified Risk Coder) in addition to coding certification
• 2+ years of coding experience working in a provider’s office
• 1+ years recent experience in a coding auditor role – auditing the work of other coders and providing feedback/coaching
• Inpatient coding experience
• Expertise in compliant querying practice and guidelines
• Knowledge of HEDIS/STARS
• Microsoft Office proficiency (Word, Excel, PowerPoint & Outlook)
• Proven excellent organizational, problem solving, and critical thinking skills
• Proven excellent verbal/written communication and interpersonal skills

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

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.