Coding Quality Auditor

UnitedHealth Group•Phoenix, AZ

12h•$60,200 - $107,400•Remote

About The Position

Optum Insight is focused on improving the flow of health data and information by connecting care providers, payers, and consumers. The Coding Quality Auditor conducts regulatory compliance audits, including audits related to regulatory agencies, quality metrics, and coding compliance. The role monitors changes in laws and regulations and establishes and implements standard policies, procedures, and best practices across Optum Middle Revenue Cycle. The auditor participates in client-facing meetings with Quality Teams, CDI, and other stakeholders associated with accounts and prebill reviews, including HAC/PSI reviews. The position maintains client relationships and represents Optum360’s values. This role can be performed by telecommuting from anywhere within the U.S., subject to UnitedHealth Group’s Telecommuter Policy.

Requirements

High school diploma or GED.
AAPC or AHIMA certification: CCS, CPC, RHIT, or RHIA.
At least 3 years of inpatient facility coding and auditing experience.
At least 1 year of experience working collaboratively with CDI and quality leadership to improve reimbursement and coding accuracy.
At least 1 year of experience with computer-assisted coding technologies and EMR coding workflows.
Intermediate proficiency with Microsoft Excel, Word, PowerPoint, and SharePoint.
Advanced organizational skills, including the ability to multitask, produce rapid turnaround, and effectively manage multiple projects.
Adherence to UnitedHealth Group’s Telecommuter Policy for telecommuters.
Ability to pass a drug test before beginning employment.

Nice To Haves

Outpatient coding experience in a coder or reviewer role.
Operational knowledge of healthcare-related Federal and State regulations and standards from regulatory agencies and accrediting organizations, such as CMS and TJC.
Demonstrated ability to work with individuals at executive, managerial, and staff levels across Corporate/National, Regional, and Local organizations, and to interact with external parties such as financial auditors, third-party payer auditors, consultants, and hospital associations.
A personal presence characterized by honesty, integrity, and caring, with the ability to inspire and motivate others in support of Optum360’s and client organizations’ philosophy, mission, vision, goals, and values.

Responsibilities

Conduct internal monitoring and audits of inpatient coding charts to identify process gaps and help address organizational risks.
Analyze audit and monitoring results to identify potential risks and communicate findings as needed.
Identify and analyze patterns and trends that may indicate compliance issues, using sources such as data analysis, news reports, and reported concerns; communicate findings as needed.
Complete internal coding quality audits and provide performance feedback to coding specialists, coding team leadership, and coding educators.
Maintain expert knowledge of coding, coding operations, coding reviews for domestic and global staff, and coding best practices; integrate Optum360 Coding business objectives within client environments.
Apply knowledge of applicable Federal, State, and local laws and regulations, Optum360’s organizational integrity program, standards of conduct, and other policies and procedures to promote ethical and professional behavior and a service-oriented culture.
Communicate the potential impact of compliance issues and risks on the business, operations, and consumers to applicable stakeholders, including segment-specific and enterprise-wide stakeholders.
Collaborate with regulators, including CMS, to prevent or address potential compliance issues.
Work with internal stakeholders across organizational lines to identify root causes of compliance issues and support appropriate risk-mitigation actions.
Develop and/or deliver training on compliance issues and risks to applicable audiences.
Consult with internal and external stakeholders, including government regulators, legal staff, and vendors, to advocate for and improve the effectiveness of compliance programs.
Partner with learning organizations as needed to develop and implement compliance training offerings.
Consult with business partners to identify effective approaches to support and enforce compliance.
Provide input on business training programs to promote inclusion of appropriate compliance content.
Assess and respond to external stakeholders’ required compliance training needs, as appropriate.
Act as liaison for external quality stakeholders, including compliance, core measures, patient safety, and premier data integrity.
Support coding team leadership with quality data reporting and work with coding educators to identify educational topics for coders.
Perform other duties as needed and assigned by Optum360 leadership.
Participate in client-facing meetings with Quality Teams, CDI, and other stakeholders associated with accounts and prebill reviews, such as HAC/PSIs.
Maintain solid client relationships and represent Optum360’s values.