Compliance Analyst - Remote Nationwide

UnitedHealth Group•Eden Prairie, MN

9d•$60,200 - $107,400•Remote

About The Position

The Compliance Analyst conducts independent, risk-based coding compliance audits of Optum Health providers and associated clinical practices. The role also reviews coding and billing investigations, evaluates coding, billing, and documentation compliance, identifies risks and audit findings, and supports remediation through reporting, root cause analysis, monitoring, and targeted education. The analyst researches coding compliance questions and stays current with applicable regulatory, coding, billing, and documentation guidelines. This role may be performed remotely from anywhere within the United States, subject to UnitedHealth Group’s Telecommuter Policy.

Requirements

High school diploma or GED.
Possess at least one of the following credentials: Certified Professional Coder (CPC), Certified Outpatient Coder (COC), Certified Coding Specialist (CCS), or Certified Coding Specialist-Physician Based (CCS-P).
At least 5 years of outpatient physician coding experience, including CPT, HCPCS, ICD-10, modifiers, and NCCI edits.
At least 5 years of healthcare regulatory compliance experience, including Medicare, Medicaid, and state and federal laws and regulations governing medical coding.
At least 3 years of experience with electronic health records (EHRs) and medical record systems.
Advanced proficiency with Microsoft Excel, Teams, PowerPoint, Word, and Outlook.
Adhere to UnitedHealth Group’s Telecommuter Policy.
Pass a drug test before beginning employment.

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 and non-E/M services, modifiers, ICD-10 coding, medical record documentation, and coding-related billing activities.
Identify compliance risks and assess adherence to CMS requirements, official coding guidelines, payer policies, and organizational standards; support corrective action and monitoring activities.
Prepare written audit scope memorandums defining audit objectives, methodology, and review criteria.
Identify audit findings, calculate billing error rates, and perform root cause analysis to support reporting and remediation planning.
Prepare written audit summary reports covering 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, aligned with applicable coding, billing, and regulatory guidance.