1+ months

DRG Coding Validation Auditor - US Remote - 914307

Minneapolis, MN 55415 Work Remotely
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  • Job Code
    914307

Energize your career with one of Healthcares fastest growing companies.

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You dream of a great career with a great company where you can make an impact and help people. We dream of giving you the opportunity to do just this. And with the incredible growth of our business, its a dream that definitely can come true. Already one of the worlds leading Healthcare companies,UnitedHealth Groupis restlessly pursuing new ways to operate our service centers, improve our service levels and help people lead healthier lives. We live for the opportunity to make a difference and right now, we are living it up.

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This opportunity is with one of our most exciting business areas:Optum a growing part of our family of companies that makeUnitedHealth Groupa Fortune 10 leader.

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Optumhelps nearly 60 million Americans live their lives to the fullest by educating them about their symptoms, conditions and treatments; helping them to navigate the system, finance their healthcare needs and stay on track with their health goals. No other business touches so many lives in such a positive way. And we do it all with every action focused on our shared values of Integrity, Compassion, Relationships, Innovation & Performance.

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This position is full-time (40 hours/week) Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 7:00am 6:00pm. It may be necessary, given the business need, to work occasional overtime. Youll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

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*All Telecommuters will be required to adhere to UnitedHealth Groups Telecommuter Policy.

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Primary Responsibilities:

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  • Investigate, review, and provide clinical and / or coding expertise in the application of medical and reimbursement policies within the claim adjudication process through file review. This could include Medical Director / physician consultations, interpretation of state and federal mandates, applicable benefit language, medical and reimbursement policies and consideration of relevant clinical information
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  • Perform clinical coverage review of claims, which requires interpretation of state and federal mandates, applicable benefit language, medical and reimbursement policies, coding requirements and consideration of relevant clinical information on claims with aberrant billing patterns
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  • Perform clinical coding review to ensure accuracy of medical coding and utilizes clinical expertise and judgment to determine correct coding and billing
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  • Knowledge of and the ability to: identify the ICD-10-CM/PCS code assignment, code sequencing, and discharge disposition, in accordance with CMS requirements, Official Guidelines for Coding and Reporting, and Coding Clinic guidance
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  • Must be fluent in application of current Official Coding Guidelines and Coding Clinic citations, in addition to demonstrating working knowledge of clinical criteria documentation requirements used to successfully substantiate code assignments
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  • Solid command of anatomy and physiology, diagnostic procedures, and surgical operations developed from specialized training and extensive experience with ICD-10-PCS code assignment
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  • Writes clear, accurate and concise rationales in support of findings
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  • Identify aberrant billing patterns and trends, evidence of fraud, waste or abuse, and recommend providers to be flagged for review
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  • Maintain and manages daily case review assignments, with a high emphasis on quality
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  • Provide clinical support and expertise to the other investigative and analytical areas
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  • Will be working in a high-volume production environment that is matrix drive
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Youll 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.

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Required Qualifications:

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  • High School Diploma / GED (or higher)
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  • 5+ years of acute care coding experience
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  • CCS (Certified Coding Specialist) or Unrestricted RN (registered nurse) with CCS
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  • Inpatient facility DRG experience (coding or auditing)
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  • Experience with ICD - 10 coding
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  • Experience with ICD - 10 PCS
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  • If you need to enter a work site for any reason, you will be required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or similar UnitedHealth Group-approved symptom screener. When in a UnitedHealth Group building, employees are required to wear a mask in common areas. In addition, employees must comply with any state and local masking orders
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Telecommuting Requirements:

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  • Required to have a dedicated work area established that is separated from other living areas and provides information privacy
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  • Ability to keep all company sensitive documents secure (if applicable)
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  • Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service
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Preferred Qualifications:

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  • RHIT (registered health information technician), RHIA (registered health information administrator), CDIP (certified documentation improvement practitioner) OR current certified facility in - patient coder
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  • Experience using Microsoft Excel with the ability to create / edit spreadsheets, use sort / filter function, and perform data entry
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  • Healthcare claims experience
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  • Managed care experience
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  • Investigation and / or auditing experience
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  • Knowledge of health insurance business, industry terminology, and regulatory guidelines
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Soft Skills:

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  • Ability to use a Windows PC with the ability to utilize multiple applications at the same time
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Physical and Work Environment:

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  • Frequent speaking, listening using a headset, sitting, use of hands / fingers across keyboard or mouse, handling other objects, long periods working at a computer
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UnitedHealth Group is an essential business. The health and safety of our team members is our highest priority, so we are taking a science driven approach to slowly welcome and transition some of our workforce back to the office with many safety protocols in place. We continue to monitor and assess before we confirm the return of each wave, paying specific attention to geography-specific trends. At this time, 90% of our non - clinical workforce transitioned to a work at home (remote) status. We have taken steps to ensure the safety of our 325,000 team members and their families, providing them with resources and support as they continue to serve the members, patients and customers who depend on us.

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You can learn more about all we are doing to fight COVID-19 and support impacted communities at: https://www.unitedhealthgroup.com/newsroom/addressing-covid.html

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Careers with OptumInsight. Information and technology have amazing power to transform the Healthcare industry and improve people's lives. This is where it's happening. This is where you'll help solve the problems that have never been solved. We're freeing information so it can be used safely and securely wherever it's needed. We're creating the very best ideas that can most easily be put into action to help our clients improve the quality of care and lower costs for millions. This is where the best and the brightest work together to make positive change a reality. This is the place to do your lifes best work.SM

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Colorado Residents Only: The hourly range for Colorado residents is $25.63 to $45.72. Pay is based on several factors including but not limited to education, work experience, certifications, etc. As of the date of this posting, In addition to your salary, UHG offers the following benefits for this position, subject to applicable eligibility requirements: Health, dental, and vision plans; wellness program; flexible spending accounts; paid parking or public transportation costs; 401(k) retirement plan; employee stock purchase plan; life insurance, short-term disability insurance, and long-term disability insurance; business travel accident insurance; Employee Assistance Program; PTO; and employee-paid critical illness and accident insurance.

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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.

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

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Keywords: DRG, coding, medical coding, RN, registered nurse, nurse, ICD-10, PCS, procedural coding, investigation, facility, in-patient, audit, DRG coding, DRG auditing, validation, coder, precertification, medical necessity, work at home, work from home, WAH, WFH, remote, telecommute, hiring immediately

Posted: 2021-03-03 Expires: 2021-05-01

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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DRG Coding Validation Auditor - US Remote - 914307

UnitedHealth Group
Minneapolis, MN 55415

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