Outpatient Facility Auditor – Remote

UnitedHealth Group
June 22, 2022
Atlanta, GA
Job Type


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

Combine two of the fastest - growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making Healthcare data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life’s best work.SM

The Outpatient Facility Auditor performs medical record audits of identified suspect CPT codes, ICD - 10 - CM diagnosis codes, as well as potential errors in billing. The Outpatient Facility Auditor validates codes by examining medical record for documentation of all procedures as well as coding. This position would be responsible for participating in code-related appeal decisions and provider calls when necessary.

This position is full - time. Employees are required to work our normal business hours of 8:00 AM - 5:00 PM. It may be necessary, given the business need, to work occasional overtime. Training will be conducted virtually from your home.

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

Primary Responsibilities:

  • Performs all necessary duties related to the Outpatient Audit process including:
    • Maintain a dedicated HIPAA-compliant home office space with access to high speed cable internet available
    • Review of outpatient hospital medical records and all associated documentation to determine the accuracy and appropriateness of outpatient coding and billing practices
    • Create audit summary documentation
    • Enter status and results into Claim Reviewer system
    • Responsibilities may be added, deleted, or changed at any time at the discretion of management, formally or informally, verbally or in writing

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: 

  • High School Diploma / GED (or higher)
  • 3+ years of experience with medical code auditing in an outpatient acute care setting
  • CPC, COC, CCS, OR CCS - P designation from AHIMA OR AAPC
  • Advanced knowledge in CPT / HCPCS coding and National Correct Coding Initiative (NCCI) edit review / resolution
  • Demonstrated competence in APC payment classification
  • Proficient in PC Windows environment
  • Ability to work any 8-hour shift between the hours of 8:00 AM - 5:00 PM including the flexibility to work occasional overtime based on business need

Preferred Qualifications: 

  • Associate’s Degree (or higher) in a related field (Health Information Technology, Health Information Management, etc.)
  • RN, RHIT, OR RHIA with a coding credential
  • Experience with defending insurance company hospital outpatient coding denials and coding auditing experience
  • Thorough understanding of 3M Encoder / grouper logic  
  • Demonstrated understanding of commercial insurance reimbursement

Telecommuting Requirements:

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

Soft Skills:

  • Ability to apply complex procedures requiring judgment
  • Competency in nonverbal, oral, and written communications particularly in the area of conflict resolution; ability to identify, define and explain day - to - day problems and solutions
  • Direct, but moderately supervised, impact on quality and efficiency of services OR operation of company OR revenues / expenses 
  • Impact on quality and efficiency of services or operation of company
  • Ability to organize complex tasks and analyze complex issues

UnitedHealth Group requires all new hires and employees to report their COVID-19 vaccination status.

Military & Veterans find your next mission: We know your background and experience is different and we like that. UnitedHealth Group values the skills, experience and dedication that serving in the military demands. In fact, many of the values defined in the service mirror what the UnitedHealth Group culture holds true: Integrity, Compassion, Relationships, Innovation and Performance. Whether you are looking to transition from active duty to a civilian career, or are an experienced veteran or spouse, we want to help guide your career journey. Learn more at https://uhg.hr/transitioning-military

Learn how Teresa, a Senior Quality Analyst, works with military veterans and ensures they receive the best benefits and experience possible. https://uhg.hr/vet

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 life’s best work.SM

Colorado, Connecticut or Nevada Residents Only: The salary range for Colorado residents is $26.15 - $46.63. The salary range for Connecticut / Nevada residents is $28.85 - $51.30. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives

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.

Keywords: #RPO, #YELLOW

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