- Performs Quality Audits focused on medical coding principles and guidelines, as well as operational performance and processes as needed.
- Extract precise information from documentation, test results, and reports to audit and ensure appropriate codes were assigned.
- Audit and test ongoing operational processes to assure continued compliance with all requirements regarding coding procedures, practices and internal processing guidelines.
- Complete audits following Quality Auditing Policy and communicate audit findings to key stakeholders on a monthly basis.
- Review claims to formulate a synopsis of facts and collaborate with Medical Services regarding the synopsis, and perform special audits as needed to ensure compliance.
- Prepare monthly dashboard reports for Medical Services to utilize in making adjustments/process improvements per findings as necessary.
- Provide detailed findings for educational opportunities in collaboration with internal stakeholders.
- Research coding and other billing regulatory issues when needed.
- Analyze issues where understanding situations or data, require in-depth knowledge of organizational objectives.
- Respond to concerns and allegations and work with internal stakeholders to develop corrective action plans, as well as, follow up appropriately to issues identified.
- Stay up to date on insurance guidelines, regulations and medical coding updates/changes through training and utilization of monthly newsletters and proactively educate departmental staff regarding changes and issues affecting physicians and coding.
- Identify process improvements that could lead to cost savings and enhancement opportunities.
- Maintain required certifications and training.
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.
- High School Diploma / GED (or higher)
- 5+ years of experience in medical billing and/or coding
- 3+ years of coding audits and/or coding quality assurance (CPT)
- Certified Professional Coder (CPC)
- Experienced in developing analysis of audit findings, creating audit reports, and presenting results.
- Expertise with NCCI (National Correct Coding Initiative) guidelines.
- Intermediate skills in Microsoft Excel – (analyze & manipulate data)
- Bachelor’s degree (or higher)
- 3+ years of Medical Claims processing
- Encoder Pro familiarity
- Ability to work on software applications systems and a willingness to learn
- Excellent analytical skills
- Excellent Interpersonal skills and ability to work well within a team environment
- Excellent verbal and written communication skill
- Thorough knowledge of anatomy and medical terminology
- Ability to manipulate large volume of data and present results
- Required to have a dedicated work area established that is separated from other living areas and provides information privacy
- Ability to keep all company sensitive documents secure (if applicable)
- Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service