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Acute Hospital Inpatient Coding Compliance Auditor

3 months ago

Eden Prairie, Minnesota, United States Optum Full time

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 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.

The Inpatient Coding Compliance Auditor will provide expert coding audit services across various acute hospital organizations for inpatient services. Review medical record documentation and related coding of inpatient encounters utilizing the ICD-10-CM/PCS classification and CMS MS-DRG system. Verify coding accuracy and that coders base code assignment in a manner consistent with relevant laws, regulations, official coding guidelines and industry standards. This individual will provide education to coders on audit results, utilize their expertise to research and respond to complex inpatient coding questions, and evaluate audit results to recommend corrective actions. The individual will have the expertise to respond to client requests to conduct ad hoc coding audits.

You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

  • Perform coding compliance and quality audits in support of Optum Insight's Compliance Program and client expectations
  • Analyze and interpret documentation from inpatient medical records
  • Clearly document audit findings, cite appropriate coding guideline references and calculate error rates
  • Provide feedback and education as appropriate depending on findings
  • Articulate audit findings appropriate for audience. Prepare written audit reports as needed summarizing audit findings and any corrective action necessary to mitigate risk
  • Serve as an expert coding resource to client organizations and provide expert coding guidance
  • Conduct ad hoc coding and billing audits as requested
  • Stay up-to-date on relevant official coding guidelines, Coding Clinic, and other industry official guidance
  • Research, develop and present coding education to coders and management as requested


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:

  • Certified Coding Specialist (CCS) certification from the American Health Information Management Association (AHIMA)
  • 6+ years acute inpatient hospital coding experience using ICD-10-CM/PCS classification
  • Extensive, current knowledge of acute hospital official coding guidelines, the ICD-10-CM/PCS classification system, MS/APR-DRG systems, and American Hospital Association (AHA) Coding Clinic for ICD-10-CM/PCS
  • Working knowledge of Microsoft Office applications, particularly Excel, Word, Outlook, OneNote and Teams
  • Working knowledge of common Electronic Health Records (EHR), encoder/grouper and computer assisted coding applications

Preferred Qualifications

  • Registered Health Information Technician (RHIT) or Registered Health Information Administrator (RHIA) certification from AHIMA
  • 6+ years of inpatient coding audit experience
  • Experience using the Optum computer assisted coding (eCAC) product, and/or other common CAC/encoder software applications
  • Experience using Cerner, Epic and/or other electronic health record (EHR) applications
  • Current knowledge and current or past experience coding acute hospital outpatient accounts such as outpatient surgery and emergency room (ED) encounters using CPT
  • Knowledge of Health Information Management or Health Information Technology

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

California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Rhode Island, or Washington Residents Only: The salary range for this role is $88,000 to $173,200 annually. 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.

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.

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.