Auditor for Surgical and Profee Coding - Remote

UnitedHealth Group Inc.•Portland, ME

33d•$28 - $50•Remote

About The Position

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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together. The Coding Support Subject Matter Expert (SME) serves as a vital resource within their respective health systems, offering expert level guidance and clarification on coding-related questions and issues. This role supports both coders and providers, ensuring accurate and compliant clinical documentation and coding practices across the organization. The SME uses their extensive knowledge of coding systems (e.g. ICD-10, CPT, HCPCS), payer requirements, and industry standards to respond to inquiries promptly and thoroughly. Additionally, the SME proactively identifies trends, knowledge gaps, or recurring issues that signal the need for broader education or systemic improvements. This role plays a key part in promoting coding accuracy, compliance, and optimal revenue integrity. You'll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges.

Requirements

AHIMA or AAPC (CCS, CPC, RHIT, RHIA) coding credential
5+ years of coding experience in a healthcare setting (inpatient, outpatient, or professional coding)
Demonstrated specialty knowledge and experience in Evaluation and Management and at least one or more of the following: Oral/Maxillofacial, Anesthesia, OB/GYN, Hematology/Oncology
Deep understanding of ICD-10, CPT, HCPCS and official coding guidelines
Proven ability to research and interpret complex coding guidelines and payer policies
Proficiency with Microsoft Excel, Word, PowerPoint, and SharePoint
Solid written and verbal communication skills
Detail oriented with solid critical thinking and problem-solving skills
Proven excellent organizational skills (ability to multi-task, produce rapid turnaround, and effectively manage multiple projects)
Proven ability to work with a variety of individuals in executive, managerial, and staff level positions

Nice To Haves

Experience providing coding support or education
Experience with physician education or clinical documentation improvement (CDI)
Knowledge of Medicare and commercial payer reimbursement methodologies
Familiarity with Cerner and 3M
All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

Responsibilities

Serve as a liaison between coding teams and providers, delivering expert guidance to resolve inquiries and concerns
Collaborate with Edits and Denials teams to analyze trends and implement educational initiatives or system edits to address recurring issues
Partner with clinical leadership during the introduction of new services to ensure accurate documentation and coding compliance
Participate in specialty and physician group meetings on a quarterly basis to provide targeted coding education and respond to ad hoc inquiries
Deliver comprehensive coding and documentation training for all newly onboarded providers
Provide annual education to providers on code set updates to maintain compliance and accuracy
Conduct annual provider audits to validate charges and supporting documentation, while identifying potential revenue opportunities
Provide targeted education and follow-up audits for providers who do not meet established quality standards
Perform ad hoc audits in response to client requests or identified concerns
Educate coders and providers on audit findings and emerging trends to promote continuous improvement
Assist coders and/or supervisors as needed on rebuttals for tri-annual audit