Quality Auditor - ED

Noida, Uttar Pradesh
Permanent
Full-time

7 days ago

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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.Primary Responsibilities:

Provide education and feedback to coders, billers, and clinical staff to reinforce correct coding practices and documentation standards
Coordinate corrective action plans (CAPs), liaise with coding education teams, and verify their implementation
Contribute to the creation and refinement of compliance audit frameworks, policies, workflows, and internal controls
Stay abreast of evolving coding standards and regulatory updates, integrating them into auditing and policy practices
Collaborate with compliance officers, internal audit teams, physician practices, management, and coding education departments
Serve as a compliance expert in departmental or organizational meetings
Identify and report potential fraud, waste, or abuse (FWA) related to billing irregularities
Use data analysis to detect outliers, unusual patterns, and high-risk practices, enabling proactive mitigation
Keep up to date with changes in coding guidelines (CMS, AMA, AHA coding clinics) and integrate them into team communication
Track assessment scores, coding performance through audits, quality reviews, providing detailed feedback and guidance
Support coders with complex case resolution, documentation improvement education, and coding clarification
Collaborate with the compliance, QA and operations teams to identify coding gaps and ensure continuous improvement
Support documentation improvement initiatives and coding clarification requests
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:

AAPC/AHIMA Certification: CPC/ CIC/ CCS/ COC/ CPMA
5+ years of hands-on Profee and Facility Emergency Department Audit experience
Solid knowledge of US healthcare RCM system
In-depth understanding of 2021 E&M guideline changes and CMS documentation
Familiarity with EMR/EHR, compliance standards, auditing platforms
Proficiency in coding software and EHR systems (EPIC. eCAC, 3M, Cerner etc.)
Proven excellent attention to detail and accuracy in coding and documentation

Preferred Qualification:

Bachelor's degree in health information management, life science or a related field

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.

UnitedHealth Group

Apply Now