Quality Assurance Auditor - Telecommute

Careers at UnitedHealth Group

We're creating opportunities in every corner of the health care marketplace to improve lives while we're building careers. At UnitedHealth Group, we support you with the latest tools, advanced training and the combined strength of high caliber co-workers who share your passion, your energy and your commitment to quality. Join us and start doing your life's best work. SM


Compassion. It's the starting point for health care providers like you and it's what drives us every day as we put our exceptional skills together with a real feeling of caring for others. This is a place where your impact goes beyond providing care one patient at a time. Because here, every day, you're also providing leadership and contributing in ways that can affect millions for years to come. Ready for a new path? Learn more, and start doing your life's best work. SM

Our teams are helping people from around the world. We can bring out your best as you put your listening, analytical and problem solving skills to work in a setting that is geared to helping improve lives and enhance health care for millions. Here, you'll discover a wealth of pathways for professional growth within Customer Service, Billing, Claims, Enrollment & Eligibility and across our global economy. Join us and find out why this is the place to do your life's best work. SM

No industry is moving faster than health care. And no organization is better positioned to lead health care forward. We need attention to every detail with an eye for the points no one has considered. The rewards for performance are significant. You'll help improve the health of millions. And you'll do your life's best work.(sm)

This role will provide coding quality auditing services to ensure compliance with Optum and CMS coding guidelines and accuracy of coding data reported. Will review provider's documentation to identify query opportunities. Must maintain compliance with Optum Coding Guidelines/policies. The minimum productivity goal is set by project, with minimum 96% coding accuracy rate required.

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

Primary Responsibilities:
  • Assists with execution of the daily activities of the Enterprise Quality Assurance program
  • Performs first level quality audits on vendor coding results
  • Identifies provider query opportunity, creates and sends compliant query to rendering provider
  • Provides support and assists on various coding initiatives, such as concurrent review, query compliance audits and retrospective coding quality reviews
  • Must be able to work with multiple coding tools and EMR systems
  • Ensure that Optum Coding Guidelines are consistently applied in all processes
  • Identifies issues and trends in coding and documentation that affect coding accuracy
  • Provides input and valuable feedback on audit results
  • Recommends process improvement
  • Perform all other related duties as assigned

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 :
  • Associate degree or equivalent experience
  • Coding Certification required (CPC, COC, CIC, CCS, CCS-P, or RHIT; the CPC-A or CCA designation is not acceptable)
  • 4+ years recent experience ICD-9/10 coding, preferably in a Managed Care setting, with strong attention to detail and high accuracy rate
  • 2+ years recent Medicare Risk Adjustment experience (HCC coding)
  • 1+ years recent experience in a coding auditor role- auditing the work of other coders and providing feedback/coaching
  • Compliant Physician query experience/knowledge
  • Proficient knowledge of CMS-HCC model and guidelines
  • ICD-10-CM proficient
  • Must be able to work during normal business hours, Monday-Friday 8am-5pm CST (flexibility to start 8 hour shift earlier or later after successful completion of training)
  • Must be able to continuously meet the requirements for a telecommuter, i.e. live in a location that can receive a UnitedHealth Group approved high speed internet connection, have a secure designated office space to maintain PHI, meet or exceed all performance expectations
  • 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

Preferred Qualifications :
  • Bachelor's degree
  • CRC (Certified Risk Coder) in addition to required coding certification
  • Inpatient coding experience
  • 2+ years' coding experience working in a provider's office
  • Microsoft Office proficiency (Word, Excel, PowerPoint & Outlook)
  • Excellent organizational, problem solving, and critical thinking skills
  • Excellent verbal/written communication and interpersonal skills
  • Knowledge of HEDIS/STARS

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)

Colorado Residents Only: The hourly range for Colorado residents is $20.77 to $36.88. 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.

*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.

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.

Job Keywords: Quality Assurance Auditor, Coding, Telecommute, Work from Home, Optum