Outpatient Facility Auditor

Requisition number: 2353481

Job category: Claims

This position is National Remote. You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Optum Insight is improving the flow of health data and information to create a more connected system. We remove friction and drive alignment between care providers and payers, and ultimately consumers. Our deep expertise in the industry and innovative technology empower us to help organizations reduce costs while improving risk management, quality and revenue growth. Ready to help us deliver results that improve lives? Join us to start Caring. Connecting. Growing together.

The Outpatient Facility Auditor (Senior Recovery Resolution Analyst) performs medical record audits of identified suspect CPT codes, ICD-10-CM diagnosis codes, and HCPCS, as well as potential errors in billing. The Outpatient Facility Auditor validates codes by examining medical record for documentation of all procedures as well as coding. This position would be responsible for participating in code-related appeal decisions and provider calls when necessary.

This position is full time (40 hours / week), Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00 am - 5:00 pm. It may be necessary, given the business need, to work occasional overtime or weekends.

This will be on the job training and the hours during training will be normal business hours from Monday - Friday.

Primary Responsibilities:

• Performs all necessary duties related to the Outpatient Audit process including:

• Maintain a dedicated HIPAA-compliant home office space with access to high speed cable internet available

• Review of outpatient hospital and ambulatory surgery centers medical records all associated documentation to determine the accuracy and appropriateness of outpatient coding and billing practices

• Create audit summary documentation

• Enter status and results into Claim Reviewer system

• Responsibilities may be added, deleted, or changed at any time at the discretion of management, formally or informally, verbally or in writing

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

• Must have one of the following coding certifications: CPC, COC, CCS, OR CCS - P with designation from AHIMA OR AAPC

• Must be 18 years of age OR older

• 2+ years of experience with medical code auditing in an outpatient facility (hospital and / or ASC (ambulatory surgery center)

• Advanced knowledge in CPT / HCPCS coding and National Correct Coding Initiative (NCCI) edit review / resolution

• Proficient in PC Windows environment

• Ability to work any of our full time (40 hours / week), 8-hour shift schedules during our normal business hours of 8:00 am - 5:00 pm from Monday - Friday, including the flexibility to work occasional overtime or weekends given the business need

Preferred Qualifications:

• RN, RHIT, OR RHIA with a coding credential

• Experience with defending insurance company hospital outpatient coding denials and coding auditing experience

• Understanding of 3M Encoder / grouper logic

• Understanding of commercial insurance reimbursement

• Competency in APC payment classification

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

Soft Skills:

• Ability to apply complex procedures requiring judgment

• Competency in oral and written communications particularly in the area of conflict resolution; ability to identify, define and explain day-to-day problems and solutions

• Direct, but moderately supervised, impact on quality and efficiency of services OR operation of company OR revenues / expenses

• Impact on quality and efficiency of services or operation of company

• Ability to organize complex tasks and analyze complex issues

*All employees working remotely 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 $28.94 - $51.63 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

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.