Health care isn't just changing. It's growing more complex every day. ICD10 replaces ICD9. Affordable Care adds new challenges and financial constraints. Where does it all lead? Hospitals and health care organizations continue to adapt, and we are a vital part of their evolution. And that's what fueled these exciting new opportunities. Optum360 is a dynamic new partnership formed by Dignity Health and Optum to combine our unique expertise. As part of the growing family of UnitedHealth Group, we'll leverage all our resources to bring financial clarity and a full suite of revenue management services to health care providers nationwide. If you're looking for a better place to use your passion and your desire to drive change, this is the place to be. It's an opportunity to do your life's best work.(sm)
The Sr. Outpatient (OP) Coding Auditor –Conducts Facility and Professional OP audits across multiple clients, in various electronic medical records and chart types/codes sets; including cardiovascular and interventional radiology (IVR/CVIR). She/he reviews documentation, code assignments, including ICD-10-CM, CPT Evaluation and Management and HCPCS codes, to ensure coding quality accuracy, consistency and in compliance with coding and billing policies and standards. The Senior Outpatient Coding Auditor conducts regular coding audits and provides education, feedback and an analysis of audit findings. She/he responds to coding/auditing questions from coders, identify patterns and trends and writes audit summary reports to support their auditing findings; noting specific coding guidelines and coding policies.
You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
- Performs coding compliance and quality audits in support of Optum360's Compliance Program and client expectations
- Analyzes and interprets documentation from medical records
- Clearly documents audit findings and calculates coding error rates
- Provides feedback and education as appropriate based on audit findings
- Articulates audit findings appropriate to the audience. Prepare written audit analysis and summary reports, including corrective action necessary to mitigate risks
- Conducts coding and billing audits as requested
- Performs internal and or external Compliance client coding and auditor reviews
- Educates and audits onshore and offshore coders and auditors
- Stays abreast of relevant Outpatient coding and billing guidelines
- Researches, develops and presents education to client coders and auditors, based on individual audit analysis
- Conducts auditor peer review audits as requested
- Ability to prioritize multiple assignments and multiple spreadsheets, documents and reports
- Serves as a resource for interventional Outpatient Audits
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.
- 5+ years of combined experience in both Professional and Facility Outpatient Audits
- 3+ years of exp in IVR/CVIR coding/audits
- Possesses good professional verbal/written communication skills
- Knowledge of NCCI/OCE billing edits as it relates to outpatient coding, auditing and billing
- Thorough knowledge of ICD-10 CM and CPT, including CPT-4 codes relevant to CVIR coding/auditing.
- Experience with various documentation and Electronic Medical Record systems and Excel.
- Experience in all Outpatient facility and professional chart types
- Industry Knowledge of Medicare regulations and payment policies, including OPPS
- Must have a current coding credential: Registered Health Information Technician (RHIT) and/or Certified Coding Specialist (CCS-P), and/or Certified Professional Coding (CPC), and/or Certified Coding Specialist (CCS), and/or Certified Coding Specialist – Professional (CCS-P)
- If not currently certified in CVIR/IVR, (Certification in Interventional Radiology) is willing to obtain the certification within 1 year of employment
- Certified Interventional Radiology Coder-CIRC
Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)
Colorado Residents Only: The salary range for Colorado residents is $64,800 to $116,000. Pay is based on several factors including but not limited to education, work experience, certifications, etc. As of the date of this posting, In addition to your salary, UHG offers the following benefits for this position, subject to applicable eligibility requirements: Health, dental, and vision plans; wellness program; flexible spending accounts; paid parking or public transportation costs; 401(k) retirement plan; employee stock purchase plan; life insurance, short-term disability insurance, and long-term disability insurance; business travel accident insurance; Employee Assistance Program; PTO; and employee-paid critical illness and accident insurance.
*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy
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.
Job Keywords: CPC, RHIT, CCS, CCS-P, CCS, CIRC, CPMA, Outpatient Auditor, Outpatient Coder, Professional Outpatient Audit, Facility Outpatient Audit, IVR, CVIR, Telecommuter