Coding and Clinical Validation Auditor

At UnitedHealth Group, we are committed to providing quality healthcare services to individuals and communities across the country. As a Coding and Clinical Validation Auditor, you will play a crucial role in ensuring the accuracy and integrity of our coding and billing processes. We are looking for a detail-oriented and knowledgeable individual who will use their expertise in coding and clinical validation to conduct audits and identify any discrepancies or errors. Join our team and make a difference in the lives of our members by ensuring the highest standards of quality and compliance.

1. Conduct coding and clinical validation audits to ensure accuracy and compliance with coding guidelines, policies, and regulations.
2. Identify and report any discrepancies or errors in coding and billing processes.
3. Utilize in-depth knowledge of coding guidelines and clinical documentation to determine appropriate coding and ensure proper reimbursement.
4. Collaborate with coding and billing teams to implement corrective action plans and improve coding accuracy.
5. Stay updated on changes in coding guidelines and regulations to ensure compliance.
6. Communicate audit findings and recommendations to relevant stakeholders.
7. Assist in the development of coding and billing training programs for staff.
8. Provide coding and clinical validation expertise to assist with claim denials and appeals.
9. Maintain confidentiality of patient information and adhere to HIPAA regulations.
10. Participate in departmental meetings and contribute to process improvement initiatives.
11. Serve as a resource for coding and billing inquiries and provide guidance to team members.
12. Maintain accurate and organized audit documentation for reporting and tracking purposes.
13. Uphold the company's commitment to providing quality healthcare services to members.
14. Adhere to company policies, procedures, and standards for ethical and professional conduct.
15. Continuously strive to improve processes and ensure the highest standards of quality and compliance.

According to JobzMall, the average salary range for a Coding and Clinical Validation Auditor in Boston, MA, USA is $70,000 - $90,000 per year. This can vary depending on factors such as experience, education, and specific job duties. Some individuals in this role may earn more or less than the average salary range.

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.