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Optum · 4 hours ago

Billing Compliance Auditor

United States

Full-time

Remote

Mid Level

$49K/yr - $87K/yr

3+ years exp

Optum is a global organization that delivers care aided by technology to help millions live healthier lives. The Billing Compliance Auditor will perform internal coding audits and billing compliance reviews, ensuring adherence to third party payer and federal regulations while providing training and education to staff and stakeholders.

EducationHealth CareMedicalPharmaceutical

Responsibilities

Responsible for performing internal coding audits and billing compliance reviews of various elements of physician billing for the organization

Works within specified third party payer and federal (CMS) coding/billing regulations

Develops training and education materials

Provides training and education to providers, clinical department and Revenue Operations staff

Provides other internal billing-related compliance services to the organization as required

Measures coding trends as compared to national standards

Review work samples from applicable reps/analysts to ensure quality/accuracy (e.g., billing processors, quality reps, collection reps)

Demonstrate understanding of applicable quality review processes (e.g., corporate reviews, individual reviews, focus reviews, review to outcome analysis)

Communicate audit/review findings to applicable stakeholders, as needed (e.g., Billing Operations, Customer Care, Optum)

Respond to inquiries from applicable stakeholders (e.g., Quality groups, Billing Operations, Customer Care, vendors), and escalate as needed and take appropriate action

Review and ensure accuracy of audit reports prior to distribution to upper management

Provide support for external audit requests, as needed (e.g. Performant)

Qualification

Certified Professional CoderAuditing physician chartsBilling software (EPIC)Microsoft Office SuiteThird party payer guidelinesProvider education skillsMedical terminologyGreat communication skillsTeamwork

Required

High School Diploma / GED

Must be 18 years of age OR older

Certified Professional Coder required (one of the following: CPC, CCS, CPMA, CEMC or COC)

3+ years of experience in a physician/professional billing environment

Experience with auditing physician chart utilizing E+M guidelines

Experience with Microsoft Office Suite (Microsoft Excel, Microsoft Word, Microsoft Power Point) or successful completion of related course

Must show proficiency in current billing software (EPIC) within six (6) months

Ability to work any of our 8-hour shift schedules during our normal business hours of 6:00 am - 6:00 pm EST. It may be necessary, given the business need, to work occasional overtime

Preferred

Great communication skills

Ability to work independently and within a team

Demonstrated experience with third party payer guidelines

Provider education/Presentation Skills

Utilize standard scoring (CMS) methodologies to report findings to providers

Ability to employ clinical reference with the auditing process

Apply CPT and ICD-10 coding convention to documentation guidelines

Apply CMS and other payer constraints to final code and documentation determination

Knowledge of medical terminology

Benefits

Comprehensive benefits package

Incentive and recognition programs

Equity stock purchase

401k contribution

Company

Optum

Glassdoor3.6

Optum is a healthcare company that provides pharmacy services, health care operations, and population health management. It is a sub-organization of UnitedHealth Group.

Founded in 2011

Eden Prairie, Minnesota, USA

10001+ employees