Quality Auditor – E/M OP

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.

Primary Responsibilities:

• Auditing coded medical records using the ICD-10 and CPT
• Know and adhere to HIPAA regulations
• Recognize, interpret and evaluate inconsistencies, discrepancies and inaccuracies in the medical data received and appropriately alert and/or query the responsible party, coder and supervisor
• Meet auditor quality and productivity standards and deadlines/turnaround times set up for the process
• Educate coders through feedback on errors
• Analyze, report and conduct sessions on error trend observed
• Conduct/participate/lead calibration calls between SMEs, auditors and trainers
• Report malpractices noticed during auditing of any coder
• Educate coders on coding updates
• Carefully demarcates between educational feedback and errors
• Reviews rebuttals with integrity
• Comply with the terms and conditions of the employment contract, company policies and procedures, and any and all directives (such as, but not limited to, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regards to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment). The Company may adopt, vary or rescind these policies and directives in its absolute discretion and without any limitation (implied or otherwise) on its ability to do so

Required Qualifications:

• Education Background
  • Graduate or Postgraduate in: Life Sciences, Allied Medicine (BHMS, BAMS, BPT, Dental Grads, Pharmacist, Nursing)
• Certification
  • Should be a certified coder – AAPC / AHIMA – CCS/CPC/CPC-H/CCS-P
• Proven good in English communication
• Thorough knowledge of medical terminology, human anatomy/ physiology, pathophysiology
• Understanding of interpreting the medications and dosages
• Minimum of 3-4 yrs. coding experience in relevant specialty
• Should be able to provide proper and detailed feedback on errors and conduct/provide training based on error trends.
• Should be able to participate/conduct/lead calibrations between SMEs, auditors and trainer group

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.