We are seeking a dedicated Remote Quality Assurance Coding Auditor to ensure adherence and CMS coding guidelines while maintaining the accuracy of reported coding data. In this role, you will review provider documentation to identify query opportunities and uphold compliance with Coding Guidelines and policies. Achieving a minimum 96% coding accuracy rate is essential.
Primary Responsibilities
Execute daily activities of the Enterprise Quality Assurance program.
Conduct initial quality audits on vendor coding results.
Identify query opportunities for providers, preparing and sending compliant queries.
Support various coding initiatives including concurrent review and retrospective coding quality reviews.
Utilize multiple coding tools and EMR systems effectively.
Ensure consistent application of Coding Guidelines across all processes.
Identify coding and documentation issues and trends affecting accuracy.
Provide constructive feedback and input on audit results.
Recommend process improvements.
Perform other related duties as assigned.
Required Qualifications
Coding Certification (CPC, COC, CIC, CCS, CCS-P, or RHIT).
4+ years of ICD-10 coding experience, preferably in Managed Care, with strong attention to detail and accuracy.
2+ years of Medicare Risk Adjustment (HCC coding) experience.
Proficient knowledge of CMS-HCC model and guidelines.
Proficiency in ICD-10-CM.
Ability to work Monday-Friday, 8am-5pm CST, with flexibility after training.
Ability to meet UnitedHealth Group's telecommuting requirements.
Preferred Qualifications
CRC (Certified Risk Coder) in addition to coding certification.
2+ years of coding experience in a provider's office.
Recent experience (1+ years) in a coding auditor role, providing feedback and coaching.
Inpatient coding experience.
Expertise in compliant querying practices and guidelines.
Knowledge of HEDIS/STARS.
Proficiency in Microsoft Office (Word, Excel, PowerPoint & Outlook).
Strong organizational, problem-solving, and critical thinking skills.
Excellent verbal/written communication and interpersonal skills.
Join us and be recognized for your contributions in a challenging environment that fosters career development and growth.
Employment Type: Full-Time
Seniority level
Mid-Senior level
Employment type
Full-time
Job function
Quality Assurance
Industries
Human Resources Services
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