Compliance Analyst - Remote Nationwide

Requisition number: 2384148

Job category: Regulatory & Compliance

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.

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

Primary Responsibilities:

• Conduct independent, risk-based coding compliance audits of Optum Health providers and associated clinical practices

• Conduct coding and billing investigation audits to assess compliance with applicable coding, billing, and documentation requirements

• Research and analyze incoming coding and billing investigation requests to support timely and accurate compliance review

• Evaluate the accuracy, completeness, and regulatory compliance of procedure coding, including E/M services, non-E/M services, modifiers, ICD-10 coding, medical record documentation, and coding-related billing activities

• Identify areas of compliance risk, assess adherence to CMS requirements, official coding guidelines, payer policies, and organizational standards, and support corrective action and monitoring activities

• Prepare written audit scope memorandums that clearly define audit objectives, methodology, and review criteria

• Identify audit findings, calculate billing error rates, and perform root cause analysis to support accurate reporting and remediation planning

• Prepare written audit summary reports that include compliance risks, trends, findings, and recommended remediation actions

• Research, develop, and deliver targeted education based on individual audit findings

• Stay current with applicable coding, billing, documentation, and regulatory guidelines

• Research, evaluate, and provide timely responses to coding compliance inquiries, ensuring alignment with applicable coding, billing, and regulatory guidance

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear directions on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

• High School Diploma/GED

• Must possess one of the following:

• Certified Professional Coder (CPC)

• Certified Outpatient Coder (COC)

• Certified Coding Specialist (CCS)

• Certified Coding Specialist-Physician Based (CCS-P)

• 5+ years of outpatient physician coding experience, including CPT, HCPCS, ICD-10, modifiers, and NCCI edits

• 5+ years of healthcare regulatory compliance experience, including Medicare, Medicaid, and state and federal laws and regulations governing medical coding

• 3+ years of experience with electronic health records (EHRs) and medical record systems

• Advanced level of proficiency with Microsoft Excel, Teams, PowerPoint, Word, and Outlook

Preferred Qualifications:

• Demonstrated ability to perform independent audit and coding review functions

• Strong professional written and verbal communication skills

• Ability to prioritize and manage multiple assignments, spreadsheets, documents, and reports

• Ability to gather, analyze, and organize data to support effective communication related to medical coding compliance

• Strong time management skills with consistent follow-through to completion

*All Telecommuters 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 salary for this role will range from $60,200 - $107,400 annually based on full-time employment. We comply with all minimum wage laws as applicable.

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

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.

#RPO #GREEN