Remote Cpc Outpatient Investigative Medical Reviewer

Company: Optum/UHG

Location: Fully Remote

Duration: 12 month contract to permanent hire (weekly pay, full benefits, and 401K included during contract portion)

Pay Rate: $28-29/hr

Looking For:

- Active CPC certification and outpatient medical coding experience

- Coding experience or auditing experience

- NCCI/CCI edits experience

- Outpatient professional coding experience

- Evaluation & management (E/M) coding experience

- Ability to work remotely from home in a home office space with a door

- Ability to have childcare and not be the primary childcare for child(ren) at home (if applicable)

- Ability to hardwire into their internet from a modem or router via ethernet cable.

- Ability to work from one home location (not another home/business) unless pre-approved by manager.

- Ability to miss none or minimal days during the 3 month training period.

- Only possess this coding position, as it is against their contractual agreement with their clients for them to have another coding position outside of this position.

Soft skills

- Working knowledge of medical terminology and claim coding.

- Strong written and verbal communications skills.

- Strong customer service skills.

- Ability to work in a team.

- Proficient with personal computers

Day-to-Day:

Investigate the client's Waste and Error stopped claims by gathering information, researching state and federal guidelines, and following internal procedures to determine the viability of the claim for further review in a production environment. This is not a hands-on medical coding role, rather more of a reviewer type position.

Perform clinical review of professional (or facility) claims vs. medical records to determine if the claim is supported or unsupported. Will be working with the client's External Commercial team consisting of other certified coders.

Top Responsibilities:

- Clinical Case Reviews -75%

- Perform clinical review of professional (or facility) claims vs. medical records to determine if the claim is supported or unsupported.

- Maintain standards for productivity and accuracy. Standards are defined by the department.

- Provide clear and concise clinical logic to the providers when necessary.

- Other internal customer correspondence and team needs 15%

- Attend and provide feedback during monthly meetings with assigned internal customer department.

- Provide continuous feedback on how to improve department relationships with internal team members and departments.

- Continue education 10%

- Keep up required Coding Certificate and/or Nursing Licensure.

- Complete compliance hours as required by the department.

Job Types: Full-time, Contract

Benefits:

• Dental insurance
• Life insurance
• Vision insurance
• Work from home
• Health insurance
• 401(k)

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday