Outpatient Facility Auditor

UnitedHealth Group•Tampa, FL

7h•$29 - $52•Remote

About The Position

This position is National Remote, offering the flexibility to telecommute from anywhere within the U.S. Optum Insight aims to improve the flow of health data and information to create a more connected system, reducing friction and driving alignment between care providers, payers, and consumers. The company leverages deep industry expertise and innovative technology to help organizations reduce costs while improving risk management, quality, and revenue growth. The Outpatient Facility Auditor, also known as a Senior Recovery Resolution Analyst, is responsible for performing medical record audits of identified suspect CPT codes, ICD-10-CM diagnosis codes, and HCPCS, as well as potential errors in billing. This role involves validating codes by examining medical records for documentation of all procedures and coding. Additionally, the auditor will participate in code-related appeal decisions and provider calls when necessary. This is a full-time position (40 hours/week), Monday through Friday, with employees required to have flexibility to work any 8-hour shift schedule during normal business hours of 8:00 am - 5:00 pm. Occasional overtime or weekend work may be required based on business needs. On-the-job training will be provided during normal business hours, Monday through Friday.

Requirements

High School Diploma / GED
Must have one of the following coding certifications: CPC, COC, CCS, OR CCS - P with designation from AHIMA OR AAPC
Must be 18 years of age OR older
2+ years of experience with medical code auditing in an outpatient facility (hospital and / or ASC (ambulatory surgery center))
Advanced knowledge in CPT / HCPCS coding and National Correct Coding Initiative (NCCI) edit review / resolution
Proficient in PC Windows environment
Ability to work any of our full time (40 hours / week), 8-hour shift schedules during our normal business hours of 8:00 am - 5:00 pm from Monday - Friday, including the flexibility to work occasional overtime or weekends given the business need
Ability to keep all company sensitive documents secure
Required to have a dedicated work area established that is separated from other living areas and provides information privacy
Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service
Ability to apply complex procedures requiring judgment
Competency in oral and written communications particularly in the area of conflict resolution; ability to identify, define and explain day-to-day problems and solutions
Direct, but moderately supervised, impact on quality and efficiency of services OR operation of company OR revenues / expenses
Impact on quality and efficiency of services or operation of company
Ability to organize complex tasks and analyze complex issues
Adhere to UnitedHealth Group’s Telecommuter Policy
Candidates are required to pass a drug test before beginning employment

Nice To Haves

RN, RHIT, OR RHIA with a coding credential
Experience with defending insurance company hospital outpatient coding denials and coding auditing experience
Understanding of 3M Encoder / grouper logic
Understanding of commercial insurance reimbursement
Competency in APC payment classification

Responsibilities

Perform all necessary duties related to the Outpatient Audit process
Maintain a dedicated HIPAA-compliant home office space with access to high speed cable internet available
Review outpatient hospital and ambulatory surgery centers medical records and all associated documentation to determine the accuracy and appropriateness of outpatient coding and billing practices
Create audit summary documentation
Enter status and results into Claim Reviewer system