Coding and Clinical Validation Auditor
Welcome to UnitedHealth Group! We are currently seeking a talented individual to join our team as a Coding and Clinical Validation Auditor. In this role, you will have the opportunity to utilize your expertise in coding and clinical validation to ensure the accuracy and compliance of medical claims. Our ideal candidate is a detail-oriented and analytical professional with a strong understanding of medical coding guidelines and regulations. If you are passionate about contributing to the healthcare industry and have a desire to make a positive impact, we encourage you to apply for this exciting opportunity!
- Review and audit medical claims to ensure accuracy and compliance with coding guidelines and regulations.
- Utilize expertise in coding and clinical validation to identify any discrepancies or errors in medical claims.
- Conduct thorough and detailed analysis of medical records to validate the services billed and ensure they align with the patient's diagnosis and treatment plan.
- Collaborate with coding and clinical teams to provide feedback and recommendations for improvement in coding processes and documentation.
- Stay up-to-date on changes and updates to coding regulations and guidelines and implement them into auditing processes.
- Communicate with healthcare providers to resolve any coding or billing discrepancies and provide education on coding guidelines and regulations.
- Maintain accurate records and documentation of audit findings and provide reports to management.
- Participate in training and development programs to continuously enhance knowledge and skills in coding and clinical validation.
- Provide support and guidance to colleagues on coding and clinical validation matters.
- Uphold the company's standards of accuracy, integrity, and quality in all coding and clinical validation audits.
Experience In Medical Coding: A Strong Understanding Of Medical Coding Guidelines, Including Icd-10, Cpt, And Hcpcs, Is Essential For This Role. Candidates Should Have At Least 3 Years Of Experience In Medical Coding, Preferably In An Auditing Role.
Clinical Knowledge: In Addition To Coding Expertise, Candidates Should Also Possess A Strong Clinical Background. This Includes Knowledge Of Medical Terminology, Disease Processes, And Treatment Protocols. A Degree In Nursing Or Another Healthcare-Related Field Is Preferred.
Auditing Experience: Previous Experience In Auditing Medical Records Is A Must. Candidates Should Be Familiar With Auditing Methodologies And Have A Proven Track Record Of Identifying Coding Errors And Discrepancies.
Certification: A Coding Certification From Ahima Or Aapc Is Required For This Role. Candidates Should Be Certified As A Certified Coding Specialist (Ccs), Certified Professional Coder (Cpc), Or Certified Risk Adjustment Coder (Crc).
Attention To Detail: As A Coding And Clinical Validation Auditor, Attention To Detail Is Critical. Candidates Should Have Excellent Analytical Skills And Be Able To Review Medical Records Thoroughly To Identify Coding And Documentation Errors. Strong Organizational Skills Are Also Important For Managing A High Volume Of Medical Records.
Communication Skills
Time Management
Attention to detail
Analytical Thinking
Medical Terminology
Problem-Solving
Clinical Knowledge
Compliance Expertise
Audit Experience
Coding Proficiency
Coding Guidelines
Communication
Conflict Resolution
Emotional Intelligence
Leadership
Time management
creativity
Teamwork
Active Listening
Adaptability
Problem-Solving
According to JobzMall, the average salary range for a Coding and Clinical Validation Auditor in Eden Prairie, MN, USA is between $70,000 and $90,000 per year. This can vary depending on factors such as experience, education, and specific job responsibilities. Additionally, bonuses and benefits may also be included in the overall compensation package.
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UnitedHealth Group Incorporated is an American for-profit managed health care company based in Minnetonka, Minnesota. UnitedHealth Group, Inc. provides health care coverage, software and data consultancy services. It operates through the following segments: UnitedHealthcare, OptumHealth, OptumInsight, and OptumRx. The UnitedHealthcare segment utilizes Optum's capabilities to help coordinate patient care, improve affordability of medical care, analyze cost trends, manage pharmacy benefits, work with care providers more effectively, and create a simpler consumer experience.
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