What are the responsibilities and job description for the Outpatient Facility Auditor - National Remote position at UnitedHealth Group?

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.

The Outpatient Facility Auditor performs medical record audits of identified suspect CPT codes, ICD - 10 - CM diagnosis codes, as well as potential errors in billing. The Outpatient Facility Auditor validates codes by examining medical record for documentation of all procedures as well as coding. This position would be responsible for participating in code-related appeal decisions and provider calls when necessary.

This position is full time (40 hours / week) Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8 : 00am - 5 : 00pm.

We offer 8 weeks of on-the-job training. The hours of the training will be aligned with your schedule.

You’ll enjoy the flexibility to telecommute

from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities :

Performs all necessary duties related to the Outpatient Audit process including : Maintain a dedicated HIPAA-compliant home office space with access to high speed cable internet availableReview of outpatient hospital medical records and all associated documentation to determine the accuracy and appropriateness of outpatient coding and billing practicesCreate audit summary documentationEnter status and results into Claim Reviewer systemResponsibilities may be added, deleted, or changed at any time at the discretion of management, formally or informally, verbally or in writing

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications :

High School Diploma / GED

Must have one of the following coding certifications : CPC, COC, CCS, OR CCS - P designation from AHIMA OR AAPC

Must be 18 years 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 full time (40 hours / week) Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8 : 00am - 5 : 00pm

Preferred Qualifications :

RN, RHIT, OR RHIA with a coding credential

Experience with defending insurance company hospital outpatient coding denials and coding auditing experience

Thorough understanding of 3M Encoder / grouper logic

Demonstrated understanding of commercial insurance reimbursement

Demonstrated competence in APC payment classification

Telecommuting Requirements :

Ability to keep all company sensitive documents secure (if applicable)

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

Soft Skills :

Ability to apply complex procedures requiring judgment

Ability to organize complex tasks and analyze complex issues

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

All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

The hourly range for this role is $28.61 to $56.06 per hour based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

Application Deadline : This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location, and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.

Diversity creates a healthier atmosphere : UnitedHealth Group is an Equal Employment Opportunity / Affirmative Action employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

Salary : $29 - $56

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Outpatient Facility Auditor - National Remote

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