UnitedHealth Group
At a glance
Location: US-CT-Hartford
Posted: 3/22/2020
Closing: 4/21/2020
Degree: Not Specified
Type: Intern
Experience: Not Specified
RN / DRG Coding Auditor - US Telecommute
UnitedHealth Group
Job description

Energizeyour career with one of Healthcare’s fastest growing companies.  

Youdream of a great career with a great company – where you can make an impact andhelp people.  We dream of giving you theopportunity to do just this.  And withthe incredible growth of our business, it’s a dream that definitely can cometrue. Already one of the world’s leading Healthcare companies, UnitedHealthGroup is restlessly pursuing new ways to operate our service centers, improveour service levels and help people lead healthier lives.  We live for the opportunity to make adifference and right now, we are living it up.

Thisopportunity is with one of our most exciting business areas: Optum – a growingpart of our family of companies that make UnitedHealth Group a Fortune 6 leader.


Optum helps nearly 60million Americans live their lives to the fullest by educating them about theirsymptoms, conditions and treatments; helping them to navigate the system,finance their healthcare needs and stay on track with their health goals. Noother business touches so many lives in such a positive way. And we do it allwith every action focused on our shared values of Integrity, Compassion,Relationships, Innovation & Performance.

Primary Responsibilities:

  • Investigate, review, and provide clinical and / or coding expertise in the application of medical and reimbursement policies within the claim adjudication process through file review. This could include Medical Director / physician consultations, interpretation of state and federal mandates, applicable benefit language, medical and reimbursement policies and consideration of relevant clinical information
  • Perform clinical coverage review of claims, which requires interpretation of state and federal mandates, applicable benefit language, medical and reimbursement policies, coding requirements and consideration of relevant clinical information on claims with aberrant billing patterns
  • Perform clinical coding review to ensure accuracy of medical coding and utilizes clinical expertise and judgment to determine correct coding and billing
  • Identify aberrant billing patterns and trends, evidence of fraud, waste or abuse, and recommend providers to be flagged for review
  • Maintain and manages daily case review assignments, with a high emphasis on quality
  • Provide clinical support and expertise to the other investigative and analytical areas
  • Will be working in a high volume production environment that is matrix drive

You’llbe rewarded and recognized for your performance in an environment that willchallenge you and give you clear direction on what it takes to succeed in yourrole as well as provide development for other roles you may be interested in.


Required Qualifications:

  • High School Diploma / GED (or higher)
  • 1+ years of medical coding experience
  • Unrestricted RN (registered nurse)
  • Inpatient facility DRG experience (coding or auditing)
  • Experience with ICD - 10 coding
  • Experience with ICD - 10 - PCS
  • Ability to work Monday through Friday, 8:00 am to 5:00 pm Central Time
Preferred Qualifications:
  • RHIT (registered health information technician), RHIA (registered health information administrator), CDIP (certified documentation improvement practitioner) OR current certified facility in - patient coder
  • Experience using Microsoft Excel with the ability to create / edit spreadsheets, use sort / filter function, and perform data entry
  • Healthcare claims experience
  • Managed care experience
  • Investigation and / or auditing experience
  • Knowledge of health insurance business, industry terminology, and regulatory guidelines
Soft Skills:
  • Ability to use a Windows PC with the ability to utilize multiple applications at the same time

Physical Requirements and Work Environment:

  • Frequent speaking, listening using a headset, sitting, use of hands / fingers across keyboard or mouse, handling other objects, long periods working at a computer
  • Have a secluded office area in which to perform job duties during the work day
  • Have high - speed internet access

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health - related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.SM


Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity / Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.


UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.


Keywords: DRG, coding, medical coding, RN, registered nurse, nurse, ICD-10, PCS, procedural coding, investigation, facility, in-patient, audit, DRG coding, DRG auditing, validation, coder, precertification, medical necessity, telecommute