Optum is seeking a Medical Coding Auditor to review claims against medical records and identify suspected waste and error. In this role, you will analyze coding accuracy, ensure compliance with state and federal guidelines, and provide clinical and coding expertise in claims review.
You will work in a telecommuting environment, manage a production-driven caseload, and collaborate with internal teams and business partners to support accurate claim decisions and quality outcomes.
Responsibilities
- Perform clinical review of CPT, HCPCS, and modifier assignments on claims
- Determine accuracy of medical coding, billing, and payment recommendations
- Apply Evaluation and Management coding principles
- Prepare detailed clinical narratives on case outcomes
- Identify aberrant billing patterns, fraud, waste, or abuse indicators
- Manage daily case assignments, quality, utilization, and productivity standards
- Provide clinical support to investigative and analytical teams
- Communicate with business partners to obtain additional information for review
Requirements & Qualifications
Required Qualifications
- Certified coder through AHIMA (CCA, CCS, CCS-P) or AAPC (CPC, CPC-I)
- 2+ years of experience as an AHIMA or AAPC certified coder
- 2+ years of CPT, HCPCS, and modifier coding experience
- 2+ years of medical record review experience
- 1+ year working in a team environment with daily production and quality standards
- 1+ year of experience in the health insurance industry using regulatory guidelines
- 1+ year of experience with Waste & Error principles
Preferred Qualifications
- Healthcare claims processing experience
- Experience with Fraud, Waste & Abuse or Payment Integrity
- Familiarity with UHC platforms such as COSMOS, Facets, CPW, NICE, ISET, and UNET
- Strong computer skills and ability to navigate multiple systems
- Intermediate proficiency with Microsoft and Adobe applications
Soft Skills
- Highly organized with strong communication skills
- Strong written communication skills
- Analytical mindset with knowledge of medical terminology and coding
- Ability to adapt to change and work independently
Benefits & Perks
Benefits and Perks
- Telecommute flexibility
- Comprehensive benefits package
- Incentive and recognition programs
- Equity stock purchase plan
- 401(k) contribution
- Career development opportunities
- Inclusive workplace culture
Location
Minnesota, US
Employment Type
Full-time
Experience Level
Associate
Remote work allowed
Yes
Posted
1 month ago