Compliance Analyst - Remote Nationwide

UnitedHealth Group•Eden Prairie, MN

3d•$60,200 - $107,400•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 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. You will enjoy the flexibility to telecommute from anywhere within the U.S. as you take on some tough challenges.

Requirements

High School Diploma/GED
Must possess one of the following: Certified Professional Coder (CPC), Certified Outpatient Coder (COC), Certified Coding Specialist (CCS), Certified Coding Specialist-Physician Based (CCS-P)
5+ years of outpatient physician coding experience, including CPT, HCPCS, ICD-10, modifiers, and NCCI edits
5+ years of healthcare regulatory compliance experience, including Medicare, Medicaid, and state and federal laws and regulations governing medical coding
3+ years of experience with electronic health records (EHRs) and medical record systems
Advanced level of proficiency with Microsoft Excel, Teams, PowerPoint, Word, and Outlook

Nice To Haves

Demonstrated ability to perform independent audit and coding review functions
Strong professional written and verbal communication skills
Ability to prioritize and manage multiple assignments, spreadsheets, documents, and reports
Ability to gather, analyze, and organize data to support effective communication related to medical coding compliance
Strong time management skills with consistent follow-through to completion

Responsibilities

Conduct independent, risk-based coding compliance audits of Optum Health providers and associated clinical practices
Conduct coding and billing investigation audits to assess compliance with applicable coding, billing, and documentation requirements
Research and analyze incoming coding and billing investigation requests to support timely and accurate compliance review
Evaluate the accuracy, completeness, and regulatory compliance of procedure coding, including E/M services, non-E/M services, modifiers, ICD-10 coding, medical record documentation, and coding-related billing activities
Identify areas of compliance risk, assess adherence to CMS requirements, official coding guidelines, payer policies, and organizational standards, and support corrective action and monitoring activities
Prepare written audit scope memorandums that clearly define audit objectives, methodology, and review criteria
Identify audit findings, calculate billing error rates, and perform root cause analysis to support accurate reporting and remediation planning
Prepare written audit summary reports that include compliance risks, trends, findings, and recommended remediation actions
Research, develop, and deliver targeted education based on individual audit findings
Stay current with applicable coding, billing, documentation, and regulatory guidelines
Research, evaluate, and provide timely responses to coding compliance inquiries, ensuring alignment with applicable coding, billing, and regulatory guidance