Auditor for Surgical and Profee Coding - Remote at Optum

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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

The Coding Support Subject Matter Expert (SME) serves as a vital resource within their respective health systems, offering expert level guidance and clarification on coding-related questions and issues. This role supports both coders and providers, ensuring accurate and compliant clinical documentation and coding practices across the organization. The SME uses their extensive knowledge of coding systems (e.g. ICD-10, CPT, HCPCS), payer requirements, and industry standards to respond to inquiries promptly and thoroughly.

Additionally, the SME proactively identifies trends, knowledge gaps, or recurring issues that signal the need for broader education or systemic improvements. This role plays a key part in promoting coding accuracy, compliance, and optimal revenue integrity.

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

Primary Responsibilities

• Serve as a liaison between coding teams and providers, delivering expert guidance to resolve inquiries and concerns
• Collaborate with Edits and Denials teams to analyze trends and implement educational initiatives or system edits to address recurring issues
• Partner with clinical leadership during the introduction of new services to ensure accurate documentation and coding compliance
• Participate in specialty and physician group meetings on a quarterly basis to provide targeted coding education and respond to ad hoc inquiries
• Deliver comprehensive coding and documentation training for all newly onboarded providers
• Provide annual education to providers on code set updates to maintain compliance and accuracy
• Conduct annual provider audits to validate charges and supporting documentation, while identifying potential revenue opportunities
• Provide targeted education and follow-up audits for providers who do not meet established quality standards
• Perform ad hoc audits in response to client requests or identified concerns
• Educate coders and providers on audit findings and emerging trends to promote continuous improvement
• Assist coders and/or supervisors as needed on rebuttals for tri-annual audit
  
  

Qualified Candidates Will Be Expected To Effectively Demonstrate

• Solid written and verbal communication skills
• Detail oriented with solid critical thinking and problem-solving skills
• Proven excellent organizational skills (ability to multi-task, produce rapid turnaround, and effectively manage multiple projects)
• Proven ability to work with a variety of individuals in executive, managerial, and staff level positions
  
  

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

• AHIMA or AAPC (CCS, CPC, RHIT, RHIA) coding credential
• 5+ years of coding experience in a healthcare setting (inpatient, outpatient, or professional coding)
• Demonstrated specialty knowledge and experience in Evaluation and Management and at least one or more of the following: Oral/Maxillofacial, Anesthesia, OB/GYN, Hematology/Oncology
• Deep understanding of ICD-10, CPT, HCPCS and official coding guidelines
• Proven ability to research and interpret complex coding guidelines and payer policies
• Proficiency with Microsoft Excel, Word, PowerPoint, and SharePoint
  
  

Preferred Qualifications

• Experience providing coding support or education
• Experience with physician education or clinical documentation improvement (CDI)
• Knowledge of Medicare and commercial payer reimbursement methodologies
• Familiarity with Cerner and 3M
• All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
  
  

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $28.27 to $50.48 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

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.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.