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Coding Compliance AnalystUnitedHealth Group • Worcester, Massachusetts, United States
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Coding Compliance Analyst

UnitedHealth Group
  • US
    Worcester, Massachusetts, United States
  • US
    Worcester, Massachusetts, United States
Apply Now

About

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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale.Join us to start Caring. Connecting. Growing together. As a Coding Compliance Analyst, you will be responsible for procedure and diagnostic coding of professional charges. Works closely with clinical department physicians and staff to ensure accurate and compliant coding and maximization of revenue through initial coding. Schedule (FT, 40 hours): Will work 8-hr shifts, Monday-Friday. Must be flexible with schedule changes depending on business need. Typical business hours range from 6am - 6pm. (Preferably EST or CST). Role is fully remote. You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities: Participates in the identification and resolution of areas requiring additional intervention through established Coding/Billing and Corporate Compliance work plans
Develops and implement clinic-wide training programs geared towards educating clinical and non-clinical support staff regarding compliance related topics and/or deficiencies identified through documentation/coding and billing compliance audits
Develops and delivers clinic-wide memorandums/educational materials pertaining to relevant revenue integrity initiatives
Identifies trends that result in lost revenue and educates provider as appropriate
Assist in the review and update of annual Revenue Integrity & Education work plan and audit schedule
Performs formal review of annual CPT/Diagnosis/HCPCS changes and prepares educational documents by specialty highlighting significant changes
Trains providers, staff, and others in small and large group sessions
Meet deadlines, productivity targets as defined in the Coding/Billing Compliance work Plan
Communicates effectively at all levels in the organization, including clinical and non-clinical support staff, managers, physicians, and medical leadership
Conducts random and scheduled internal audits of physician billing and medical records documentation to ensure: Correct Coding (CPT, ICD-10, HCPCS, Modifiers), Accurate Data Entry, Accurate Charge Preparation/Processing, Compliance with governmental and third-party billing regulations
Conducts quarterly audits of Coding staff to ensure correct coding and to identify training opportunities
Utilizes Microsoft Excel / Word, to document and report audit results to the appropriate personnel, including physicians/providers and Medical Leadership
Works collaboratively with clinical department physicians, mid-level providers, and other staff to ensure appropriate and compliant documentation, coding, and billing practices
Develops and tracks progress of internal audit schedules
Serves as an internal compliance resource for Patient Accounts, Clinical departments, and for coding and documentation questions
Utilizes the Internet, intranet, internal reference library, available workshops and/or seminars and other sources to stay current with government and local third-party payer coding, specialty specific and reimbursement rules, and requirements
Measures and reports coding trends as compared to national standards; or claim/documentation reviews. Documents and reports result to all appropriate parties
Monitors and productivity reports and other data as requested by manager
Participate in all governmental and third-party insurance audits
Assist in developing Revenue Integrity and Education Policies and Procedures
Comply with all established departmental policies, procedures, and objectives
Maintains all Professional certifications
Attends a variety of meetings as required or directed
Performs other similar and related duties as required or directed
Must be able to work as a team and independently as needed
Regular, reliable, and predicable attendance is required
What are the reasons to consider working for UnitedHealth Group? Put it all together - competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include:
Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays
Medical Plan options along with participation in a Health Spending Account or a Health Saving account
Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage
401(k) Savings Plan, Employee Stock Purchase Plan
Education Reimbursement
Employee Discounts
Employee Assistance Program
Employee Referral Bonus Program
Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)
You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear directions 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 (or higher)
Certified Professional Coder (CPC, CCS-P, CEMC, CPMA or COC)
1+ years of experience utilizing standard scoring (CMS) methodologies to report findings to providers
1+ years of experience employing clinical references with the auditing process
1+ years of experience with Apply CPT and ICD-10 coding convention to documentation guidelines
1+ years of experience with Apply CMS and other payer constraints to final code and documentation determination
1+ years of demonstrated experience in a physician/professional billing environment
1+ years of demonstrated experience with third party payer guidelines
Ability to obtain CPMA within 1 year of employment
Preferred Qualifications: Experience with ICD-10, CPT and HCPCS coding
Experience with auditing physician medical records utilizing E+M guidelines
Experience with Microsoft Office Suite (Excel, Word, Power Point) or successful completion of related courses. Must show proficiency in current billing software within six (6) months
Demonstrated experience in the application of medical terminology, anatomy and physiology or successful completion of related college courses
*All Telecommuters 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 $23.89 to $42.69 per hour based on full-time employment. We comply with all minimum wage laws as applicable. Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records. 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. 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. #RPO #GREEN
  • Worcester, Massachusetts, United States

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  • English
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