Inpatient Coding Compliance Auditor for Acute Care Facilities

1 week ago

Eden Prairie, Minnesota, United States UnitedHealth Group Full time

At UnitedHealth Group, we are dedicated to enhancing healthcare through innovative technology and comprehensive services. Our mission is to connect individuals with the necessary resources to lead healthier lives. We foster a culture of diversity and inclusion, where talented professionals can thrive and contribute to meaningful health outcomes. Join us in our commitment to advancing health equity globally.

The Inpatient Coding Compliance Auditor plays a crucial role in providing specialized coding audit services across various acute care organizations. This position involves reviewing medical record documentation and coding for inpatient encounters using the ICD-10-CM/PCS classification and CMS MS-DRG system. The auditor will ensure coding accuracy and adherence to relevant laws, regulations, and official coding guidelines. Additionally, this role includes educating coders on audit findings, addressing complex coding inquiries, and recommending corrective actions based on audit evaluations.

Key Responsibilities:

  • Conduct coding compliance and quality audits to support the Compliance Program and meet client expectations.
  • Analyze and interpret documentation from inpatient medical records.
  • Document audit findings clearly, referencing appropriate coding guidelines and calculating error rates.
  • Provide constructive feedback and education based on audit results.
  • Prepare comprehensive audit reports summarizing findings and necessary corrective actions.
  • Act as a coding expert for client organizations, offering guidance and support.
  • Perform ad hoc coding and billing audits as required.
  • Stay informed on official coding guidelines, Coding Clinic updates, and industry standards.
  • Develop and present coding education for coders and management as needed.

In this role, you will be recognized for your contributions in a challenging environment that provides clear direction for success and opportunities for professional growth.

Required Qualifications:

  • Certified Coding Specialist (CCS) certification from the American Health Information Management Association (AHIMA).
  • 6+ years of experience in acute inpatient hospital coding using ICD-10-CM/PCS classification.
  • Extensive knowledge of acute hospital coding guidelines, ICD-10-CM/PCS classification, MS/APR-DRG systems, and AHA Coding Clinic.
  • Proficiency in Microsoft Office applications, particularly Excel, Word, Outlook, OneNote, and Teams.
  • Familiarity with 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 experience in inpatient coding audits.
  • Experience with Optum computer-assisted coding (eCAC) products or other common CAC/encoder software.
  • Experience with Cerner, Epic, or other electronic health record (EHR) systems.
  • Current knowledge of coding for acute hospital outpatient accounts, including outpatient surgery and emergency room encounters using CPT.
  • Understanding of Health Information Management or Health Information Technology.

UnitedHealth Group is committed to creating a diverse environment and is proud to be an equal opportunity employer. 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.

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