Remote Inpatient Coding Auditor Jobs in Massachusetts

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.   

You will enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Codes a variety of medical records using CPT, HCPCS and ICD-10 codes for office, outpatient, inpatient, surgical, hospital ancillary, nursing facility, urgent care, ambulatory surgery center and other charges for physicians and other providers of professional billing
• Prepare, review, and transmit claims using billing software, including electronic and paper claim processing
• Contacts providers or their representatives regarding inappropriate, incomplete or unclear coding
• Search for information in cases where the coding is complex or unusual. Forward unresolved coding questions to manager for review and comment
• Ensure codes are accurate and sequenced correctly in accordance with government and insurance regulations
• Works directly with the auditors on coding documentation errors and payor updates. Communicates back to the team when appropriate
• Works with manager on workload to ensure month end completion and accuracy
• Follows up on outstanding coding related receivables following standard Revenue Operations policy/procedure/process and based upon payer filing deadlines
• Initiate refunds when appropriate for all third-party insurance receipts in accordance with governmental and insurance contract agreements
• Ensures appropriateness of payer rejections and denials for coding related reasons
• Contacts payers/governmental agencies regarding coding related denials and appeals as appropriate following established Revenue Operations policy/procedure/process
• Notify manager of any coding denial trends
• Responds to coding related inquiries from providers and support staff and others as requested
• Must keep current of governmental and other payor coding and reimbursement rules and requirements
• Maintains productivity, quality standards and processing timelines as established by Revenue Operations Metrics
• Ensures compliance with payer filing deadlines
• Cooperates fully with all governmental and third-party insurer audits
• Adheres to all governmental and third-party compliance issues as directed
• Complies with health and safety requirements and with regulatory agencies such as DPH, etc. 
• Complies with established departmental policies, procedures, and objectives
• Enhance professional growth and development through educational programs, webinars, etc. 
• Performs other similar and related duties as required or directed
• Regular, reliable and predicable attendance is required

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 equivalent experience
• Certified Coder: CPC, CCS-P, CCS, CPC-H
• Medical terminology certificate or demonstrated knowledge
• 2 years of coding work experience
• 6 months of experience and proficiency in current billing software
• Intermediate level of knowledge and experience in ICD-10, CPT and HCPCS coding or successful completion of related college courses
• Demonstrated knowledge of third-party billing
• Ability to work independently and as part of a team
• Ability to demonstrate a professional and courteous manner when interacting with physicians/providers, clinical department staff and co-workers
• Excellent organizational and communication skills

*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 $24 - $43 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.

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