[Remote] Billing Compliance Auditor

Note: The job is a remote job and is open to candidates in USA. Optum is a global organization that delivers care aided by technology to help millions live healthier lives. The Billing Compliance Auditor will perform internal coding audits and billing compliance reviews, ensuring adherence to third party payer and federal regulations while providing training and education to staff and stakeholders. Responsibilities • Responsible for performing internal coding audits and billing compliance reviews of various elements of physician billing for the organization • Works within specified third party payer and federal (CMS) coding/billing regulations • Develops training and education materials • Provides training and education to providers, clinical department and Revenue Operations staff • Provides other internal billing-related compliance services to the organization as required • Measures coding trends as compared to national standards • Review work samples from applicable reps/analysts to ensure quality/accuracy (e.g., billing processors, quality reps, collection reps) • Demonstrate understanding of applicable quality review processes (e.g., corporate reviews, individual reviews, focus reviews, review to outcome analysis) • Communicate audit/review findings to applicable stakeholders, as needed (e.g., Billing Operations, Customer Care, Optum) • Respond to inquiries from applicable stakeholders (e.g., Quality groups, Billing Operations, Customer Care, vendors), and escalate as needed and take appropriate action • Review and ensure accuracy of audit reports prior to distribution to upper management • Provide support for external audit requests, as needed (e.g. Performant) Skills • High School Diploma / GED • Must be 18 years of age OR older • Certified Professional Coder required (one of the following: CPC, CCS, CPMA, CEMC or COC) • 3+ years of experience in a physician/professional billing environment • Experience with auditing physician chart utilizing E+M guidelines • Experience with Microsoft Office Suite (Microsoft Excel, Microsoft Word, Microsoft Power Point) or successful completion of related course • Must show proficiency in current billing software (EPIC) within six (6) months • Ability to work any of our 8-hour shift schedules during our normal business hours of 6:00 am - 6:00 pm EST. It may be necessary, given the business need, to work occasional overtime • Great communication skills • Ability to work independently and within a team • Demonstrated experience with third party payer guidelines • Provider education/Presentation Skills • Utilize standard scoring (CMS) methodologies to report findings to providers • Ability to employ clinical reference with the auditing process • Apply CPT and ICD-10 coding convention to documentation guidelines • Apply CMS and other payer constraints to final code and documentation determination • Knowledge of medical terminology Benefits • Comprehensive benefits package • Incentive and recognition programs • Equity stock purchase • 401k contribution Company Overview • Optum is a healthcare company that provides pharmacy services, health care operations, and population health management. It is a sub-organization of UnitedHealth Group. It was founded in 2011, and is headquartered in Eden Prairie, Minnesota, USA, with a workforce of 10001+ employees. Its website is Apply tot his job