Billing Compliance Auditor

UnitedHealth Group • Dallas, TX

126d • $23 - $41

About The Position

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 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. 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.

Requirements

• High School Diploma / GED
• Must be 18 years of age 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
• 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

Nice To Haves

• Great communication
• Able to work independently and within a team
• Experience with third party payer 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

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).

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Industry: Insurance Carriers and Related Activities
• Education Level: High school or GED
• Number of Employees: 5,001-10,000 employees