Outpatient Facility Auditor
UnitedHealth Group, Dallas, TX, United States
This position is National Remote. You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
Optum Insight
is improving the flow of health data and information to create a more connected system. We remove friction and drive alignment between care providers and payers, and ultimately consumers. Our deep expertise in the industry and innovative technology empower us to help organizations reduce costs while improving risk management, quality and revenue growth. Ready to help us deliver results that improve lives? Join us to start
Caring. Connecting. Growing together.
The
Outpatient Facility Auditor
(Senior Recovery Resolution Analyst) performs medical record audits of identified suspect CPT codes, ICD-10-CM diagnosis codes, and HCPCS, 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 8:00 am - 5:00 pm. It may be necessary, given the business need, to work occasional overtime or weekends.
This will be on the job training and the hours during training will be normal business hours from Monday - Friday.
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 available
Review of outpatient hospital and ambulatory surgery centers medical records 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
Responsibilities 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 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
Preferred Qualifications
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
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
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
*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $28.94 - $51.63 per hour based on full-time employment. We comply with all minimum wage laws as applicable.
UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.
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Optum Insight
is improving the flow of health data and information to create a more connected system. We remove friction and drive alignment between care providers and payers, and ultimately consumers. Our deep expertise in the industry and innovative technology empower us to help organizations reduce costs while improving risk management, quality and revenue growth. Ready to help us deliver results that improve lives? Join us to start
Caring. Connecting. Growing together.
The
Outpatient Facility Auditor
(Senior Recovery Resolution Analyst) performs medical record audits of identified suspect CPT codes, ICD-10-CM diagnosis codes, and HCPCS, 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 8:00 am - 5:00 pm. It may be necessary, given the business need, to work occasional overtime or weekends.
This will be on the job training and the hours during training will be normal business hours from Monday - Friday.
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 available
Review of outpatient hospital and ambulatory surgery centers medical records 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
Responsibilities 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 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
Preferred Qualifications
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
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
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
*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $28.94 - $51.63 per hour based on full-time employment. We comply with all minimum wage laws as applicable.
UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.
#J-18808-Ljbffr