HartfordRecruiter Since 2001
the smart solution for Hartford jobs

DRG Coding Validation Auditor - Remote

Company: UnitedHealth Group
Location: Hartford
Posted on: November 15, 2021

Job Description:

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
This position is full-time (40 hours/week) Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 7:00am - 6:00pm. 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:
Investigate, review, and provide clinical and / or coding expertise in the application of medical and reimbursement policies within the claim adjudication process through file review. This could include Medical Director / physician consultations, interpretation of state and federal mandates, applicable benefit language, medical and reimbursement policies, and consideration of relevant clinical information
Perform clinical coverage review of claims, which requires interpretation of state and federal mandates, applicable benefit language, medical and reimbursement policies, coding requirements and consideration of relevant clinical information on claims with aberrant billing patterns
Perform clinical coding review to ensure accuracy of medical coding and utilizes clinical expertise and judgment to determine correct coding and billing
Knowledge of and the ability to: identify the ICD-10-CM/PCS code assignment, code sequencing, and discharge disposition, in accordance with CMS requirements, Official Guidelines for Coding and Reporting, and Coding Clinic guidance
Must be fluent in application of current Official Coding Guidelines and Coding Clinic citations, in addition to demonstrating working knowledge of clinical criteria documentation requirements used to successfully substantiate code assignments
Solid command of anatomy and physiology, diagnostic procedures, and surgical operations developed from specialized training and extensive experience with ICD-10-PCS code assignment
Writes clear, accurate and concise rationales in support of findings
Identify aberrant billing patterns and trends, evidence of fraud, waste, or abuse, and recommend providers to be flagged for review
Maintain and manages daily case review assignments, with a high emphasis on quality
Provide clinical support and expertise to the other investigative and analytical areas
Will be working in a high-volume production environment that is matrix drive
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)
5+ years of acute care coding experience
Experience with ICD - 10 coding
Experience with ICD - 10 - PCS
Inpatient facility DRG experience (coding or auditing)
Ability to obtain CCS (Certified Coding Specialist) or CIC (Certified Inpatient Coder) within 6 months of hire at own expense
Ability to use a Windows PC with the ability to utilize multiple applications at the same time
Preferred Qualifications:
Healthcare claims experience
Managed care experience
Investigation and / or auditing experience
Knowledge of health insurance business, industry terminology, and regulatory guidelines
RHIT (registered health information technician), RHIA (registered health information administrator), CDIP (certified documentation improvement practitioner) OR current certified facility in - patient coder
Experience using Microsoft Excel with the ability to create, edit, and sort spreadsheets, basic analytical formulas (VLOOKUP, if), filter function, and perform data entry
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
Physical and Work Environment:
Frequent speaking, listening using a headset, sitting, use of hands / fingers across keyboard or mouse, handling other objects, long periods working at a computer
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 $25.63 to $45.72. The salary range for Connecticut / Nevada residents is $28.27 to $50.29. 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: DRG, coding, medical coding, RN, registered nurse, nurse, ICD-10, PCS, procedural coding, investigation, facility, in-patient, audit, DRG coding, DRG auditing, validation, coder, precertification, medical necessity, work at home, work from home, WAH, WFH, remote, telecommute, hiring immediately, #rpo

Keywords: UnitedHealth Group, Hartford , DRG Coding Validation Auditor - Remote, Accounting, Auditing , Hartford, Connecticut

Click here to apply!

Didn't find what you're looking for? Search again!

I'm looking for
in category
within


Log In or Create An Account

Get the latest Connecticut jobs by following @recnetCT on Twitter!

Hartford RSS job feeds