Claims Coding Compliance Supervisor

2 weeks ago


San Jose, California, United States UnitedHealth Group Full time

About UnitedHealth Group:
UnitedHealth Group is a leading global organization dedicated to enhancing healthcare through innovative technology and services that empower individuals to lead healthier lives.

Role Overview:
As a Claims Coding Compliance Supervisor, you will play a crucial role in overseeing the daily operations of the claims review team. Your leadership will directly contribute to the accuracy and integrity of claims processing, ensuring that our services meet the highest standards of compliance and quality.

Key Responsibilities:
- Supervise and mentor a team responsible for reviewing claims and resolving discrepancies.
- Conduct both focused and routine audits to assess coding accuracy and documentation quality.
- Communicate findings related to high-profile claims issues to relevant stakeholders.
- Oversee external audits and ensure adherence to the annual Claims Review plan.
- Monitor claims payment errors and examiner productivity for compliance reporting.
- Develop training materials and conduct training sessions for claims examiners on procedures and systems.
- Identify and resolve claims issues, documenting results for continuous improvement.
- Serve as a resource for management and other departments regarding claims-related inquiries.
- Collaborate with management to address trends and enhance claims processing accuracy.

Qualifications:
- Minimum of 2 years of experience in a supervisory role within medical claims.
- Certification from the American Academy of Professional Coders (AAPC) is required.
- Familiarity with Medicare, Medicaid, and Managed Care claims processing.
- Strong knowledge of healthcare regulations, including CMS and DHCS guidelines.
- Proficiency in Microsoft Excel and other relevant software.

Skills and Attributes:
- Detail-oriented with strong analytical skills.
- Ability to communicate effectively with diverse audiences.
- Proven leadership capabilities, with experience in managing and developing staff.
- Ability to maintain confidentiality and handle sensitive information responsibly.

Work Environment:
This position offers the flexibility to work remotely, allowing you to balance professional responsibilities with personal commitments.

Commitment to Diversity:
At UnitedHealth Group, we value diversity and strive to create an inclusive environment for all employees. We are committed to equal employment opportunities and encourage applicants from all backgrounds to apply.



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