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 diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

Positions in this function are responsible for all aspects of quality assurance within the Billing job family. Conducts audits and analysis and provides feedback to reduce errors and improve processes, design, and performance.

This position is full-time. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 6:00am – 6:00pm EST, Monday – Friday. It may be necessary, given the business need, to work occasional overtime.

We offer 12 weeks of paid training. The hours of the training will be aligned with your schedule.

If you are located within Eastern Standard Time Zone, you will have the flexibility to work remotely* as you take on some tough challenges.

Primary Responsibilities:

• Review work samples from applicable reps/analysts to ensure quality/accuracy (e.g., billing processors, quality reps, collection reps)

• Ensure that all relevant information from insurance applications is accurately entered into applicable systems

• Demonstrate understanding of applicable quality review processes (e.g., corporate reviews, individual reviews, focus reviews, review to outcome analysis)

• Ensure that month-end sampling deadlines are met

• Communicate audit/review findings to applicable stakeholders, as needed (e.g., Billing Operations, Customer Care, Optum)

• Respond to inquiries from applicable stakeholders (e.g., Quality groups, Billing Operations, Customer Care, vendors), and escalate as needed

• Identify data changes since the original request was entered (e.g., LIS updates, changes to plan effective dates, MOP changes), and take appropriate action

• Review and ensure accuracy of audit reports prior to distribution to upper management

• Provide support for external audit requests, as needed (e.g., SOX)

• Monitor placements and deliver recon reports sent from applicable clients (e.g., facilities, hospitals)

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 be 18 years of age OR Older

• Certified Professional Coder required (CPC, CCS, CPMA, CEMC, COC)

• 3+ years of experience in ICD-10, CPT and HCPCS coding

• Experience with auditing physician medical records utilizing E+M guidelines

• Utilize standard scoring (CMS) methodologies to report findings to providers

• Ability to employ clinical reference with the auditing process

• Apply CPT and ICD-10 coding convention to documentation guidelines

• Apply CMS and other payer constraints to final code and documentation determination

• Knowledge of medical terminology

• 3+ years of experience in a physician/professional billing environment

• Experience with third party payer guidelines

• Experience with Microsoft Office Suite (Excel) Word, Power Point) or successful completion of related course

• Must show proficiency in current billing software (EPIC) within six (6) months

• Ability to work any of our 8-hour shift schedules during our normal business hours of 6:00am – 6:00pm, Monday – Friday. It may be necessary, given the business need, to work occasional overtime

Preferred Qualifications:

• Great communication

• Able to work independently and within a team

Telecommuting Requirements:

• Reside within the state of Eastern Time Zone

• 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

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

Connecticut, New York, Rhode Island, Washington, D.C. Residents Only: The hourly range for this role is $23.22 to $45.43 per hour. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

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.

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.

#RPO