Note: The job is a remote job and is open to candidates in USA. UnitedHealth Group is a global organization that delivers care aided by technology to help people live healthier lives. The Special Investigations Unit Pre Pay Coding Consultant investigates and resolves healthcare fraud and abuse by reviewing prepay claims, medical records, policies, CPT guidelines, and contracts, while providing coding guidance and supporting internal and external stakeholders.
Responsibilities
- Reviews prepay claims with corresponding medical records to determine payment accuracy. (70%)
- Reviews applicable policies, CPT guidelines and contracts as they pertain to clinical review. (10%)
- Participates in regulatory meetings with the client (5%)
- Participates in meetings with providers, advocates and legal to assist with provider abrasion. (5%)
- Performs additional projects as needed by the business or Client; analyzes data; meets with internal and external stakeholders as necessary for resolution. (5%)
- Continuous monitoring of claim inventory in order to adhere to performance guarantees. (5%)
Skills
- High School Diploma/GED
- Certified Coder with credentials from AAPC with a CPC or AHIMA with CCS, RHIT, RHIA
- 3+ years of CPT coding experience
- Recent professional coding/auditing experience within the last 1-2 years
- Intermediate level of proficiency with PC based software
- Ability to work our normal business hours of 8:00am - 5:00pm, Monday - Friday. It may be necessary, given the business need, to work occasionally overtime or weekends
- Must be 18 years of age or older
- Ability to prioritize and manage multiple tasks
- Proven ability to work in a team setting
- Excellent oral and written communication skills and presentation skills
- Experience with health insurance billing/coding
Benefits
- Flexibility to telecommute from anywhere within the U.S.
- Comprehensive benefits package
- Incentive and recognition programs
- Equity stock purchase
- 401k contribution
- Development for other roles you may be interested in
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