Outpatient Facility Auditor

This position is National Remote, offering flexibility to telecommute from anywhere within the U.S. Optum Insight works to improve health data flow to create a connected system by aligning care providers, payers, and consumers to reduce costs and improve quality and revenue growth.

The Outpatient Facility Auditor (Senior Recovery Resolution Analyst) performs medical record audits on suspect CPT, ICD-10-CM, and HCPCS codes, reviewing billing accuracy and appropriateness by examining medical records and documentation. The role participates in code-related appeal decisions and provider calls as needed.

This is a full-time position (40 hours/week), Monday through Friday, with flexible 8-hour shifts within the 8:00 am - 5:00 pm business hours and occasional overtime or weekend work as business needs dictate. Training occurs during normal business hours.

Primary responsibilities include audit process duties, maintaining HIPAA-compliant home office with high-speed internet, reviewing outpatient hospital and ambulatory surgery center records for coding/billing accuracy, creating audit summaries, and entering results into the Claim Reviewer system.

Required qualifications:

• High School Diploma or GED
• Valid coding certification (CPC, COC, CCS, CCS-P) from AHIMA or AAPC
• At least 18 years old
• 2+ years experience in outpatient facility medical code auditing
• Advanced knowledge of CPT/HCPCS coding and National Correct Coding Initiative (NCCI) edit review
• Proficiency with PC Windows environment
• Flexibility for scheduled shifts and occasional overtime/weekends

Preferred qualifications:

• RN, RHIT, or RHIA with coding credential
• Experience defending hospital outpatient coding denials and auditing
• Understanding of 3M Encoder/grouper logic and APC payment classification
• Knowledge of commercial insurance reimbursement

Candidates must have a secure, dedicated work area meeting UnitedHealth Group telecommuting policies with approved high-speed internet.

Strong communication skills, judgment in complex procedures, conflict resolution ability, and capacity to organize and analyze complex tasks are essential.

Compensation range is approximately $28.94 to $51.63 per hour based on full-time employment, plus a comprehensive benefits package including incentive programs, equity stock purchase, and 401k contributions.