Compliance Auditor
2 weeks ago
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 resources 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 Compliance Auditor position (Sr. Compliance Analyst) will report to the Sr. Compliance Auditor. In this role, the Compliance Auditor will provide ongoing compliance monitoring and auditing for Optum Behavioral Care, ensuring adherence to medical coding guidelines and regulatory requirements. This position will involve reviewing billing, coding, documentation, and related processes to ensure appropriate reimbursement and compliance with applicable laws and regulations related to medical coding. The Compliance Auditor will also provide compliance education and training related to coding and billing regulations, respond to compliance inquiries, and assist with special compliance projects.
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 and billing audit reviews of existing centers and potential acquisitions, identifying and reporting errors under tight deadlinesCollaborate with OBC and Optum Compliance team members to monitor and research updated guidance regarding medical coding regulations, documentation requirements, and related issuesAssist with compliance monitoring and assessments, supporting corrective action processes and insurance carrier and regulatory auditsContribute to the development, update, revision, and implementation of policies, procedures, and practices for general compliance and revenue cycle, with a focus on medical coding regulationsCoordinate with other departments to gather information for regulatory reviews and audits related to medical coding complianceInvestigate, audit, review, and analyze general compliance requirements, including Medicare, Medicaid, ACA, HIPAA, and other regulations specific to medical codingReview training materials for compliance with company policy and regulatory requirements, with a focus on coding and billing regulationsIdentify audit opportunities based on industry performance, regulatory focus areas, and internal risk areas, specifically related to medical coding complianceMaintain open lines of communication to effectively present department services, policies, procedures, and programs related to medical coding complianceProduce accurate and concise work products related to medical coding compliance that do not require revisionsCollaborate effectively within multidisciplinary teams to ensure compliance with medical coding regulationsYou’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:
CPC (Certified Professional Coder) and CPMA (Certified Professional Medical Auditor) 3+ years of experience as a certified coder in a corporate/professional healthcare position or related fieldIn-depth knowledge of healthcare regulatory compliance, particularly Medicare, Medicaid, and state and federal laws and regulations governing medical codingFamiliarity with electronic health records (EHR) and medical records systemsProficiency in Microsoft Office, particularly ExcelProven ability to work in both office and remote environmentsProven ability to gather, analyze, and organize data for effective communication related to medical coding complianceProven ability to work with colleagues and clients in a patient, empathetic, and organized manner, with a focus on medical coding complianceProven analytical reasoning and problem-solving abilities specific to medical coding complianceProven presentation, training, and speaking skills related to medical coding regulations and compliancePreferred Qualifications:
Other coding certifications such as Certified Outpatient Coder (COC), Certified Coding Specialist (CCS), Certified Coding Specialist-Physician Based (CCS-P) or similar Experience as a compliance coding auditorExperience in behavioral healthExperience working with Athena Experience with Microsoft Teams/SharePoint Proven solid organizational and coordination skills
*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 $58, to $, 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 k 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.
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