Coding and Clinical Validation Auditor
Welcome to UnitedHealth Group, where we are dedicated to helping people live healthier lives and making the healthcare system work better for everyone. We are seeking a highly qualified and motivated individual to join our team as a Coding and Clinical Validation Auditor. In this role, you will play a crucial part in ensuring the accuracy and compliance of medical coding and clinical documentation. With your expertise, you will help us provide high-quality care to our members while also maintaining regulatory standards. If you have a passion for healthcare and a strong attention to detail, we invite you to apply for this opportunity to make a positive impact on the lives of others.
- Conduct thorough and accurate audits of medical coding and clinical documentation to ensure compliance with coding guidelines and regulatory standards.
- Identify and communicate any discrepancies or potential issues to appropriate parties for resolution.
- Collaborate with coding and clinical teams to provide education and training on coding and documentation best practices.
- Stay up-to-date on industry changes and updates related to coding and documentation guidelines.
- Utilize coding software and tools to review and validate codes and diagnoses.
- Maintain detailed and organized audit documentation for reference and reporting purposes.
- Communicate audit findings and recommendations to management and other stakeholders.
- Work with cross-functional teams to implement process improvements and ensure accuracy and efficiency in coding and documentation practices.
- Adhere to all confidentiality and privacy regulations when handling sensitive patient information.
- Continuously monitor and evaluate coding and documentation processes to identify areas for improvement and implement solutions.
- Provide support and guidance to coding and clinical teams on coding and documentation queries and issues.
- Participate in training and development opportunities to further enhance coding and auditing skills.
- Represent UnitedHealth Group in a professional and positive manner at all times.
- Demonstrate a commitment to the company's mission and values of promoting healthier lives and improving the healthcare system.
Extensive Knowledge Of Coding Guidelines And Regulations: A Coding And Clinical Validation Auditor At Unitedhealth Group Should Have A Thorough Understanding Of Coding Guidelines, Such As Icd-10 And Cpt, As Well As Regulations Like Hipaa And Cms Rules.
Certified Professional Coder (Cpc) Certification: Unitedhealth Group Typically Requires Candidates For This Role To Hold Cpc Certification, Demonstrating Proficiency In Coding And Billing Practices.
Clinical Background: A Clinical Background, Such As A Nursing Degree Or Experience As A Healthcare Provider, Is Often Preferred For This Role As It Provides A Thorough Understanding Of Medical Terminology And Procedures.
Strong Analytical And Problem-Solving Skills: As A Coding And Clinical Validation Auditor, One Must Be Able To Identify And Investigate Discrepancies In Coding And Clinical Documentation, And Provide Solutions To Improve Accuracy And Compliance.
Communication And Teamwork: This Role Requires Strong Communication Skills To Effectively Collaborate With Other Team Members, Healthcare Providers, And External Auditors. The Ability To Work Well In A Team And Contribute To A Positive Work Environment Is Also Important.
Quality Assurance
Data Analysis
Auditing
Compliance
ICD-10
Clinical documentation
Medical coding
Cpt Coding
Revenue Cycle
Chart Review
Coding Guidelines
Communication
Conflict Resolution
Emotional Intelligence
Leadership
Time management
creativity
Teamwork
Adaptability
Problem-Solving
Decision-making
According to JobzMall, the average salary range for a Coding and Clinical Validation Auditor in Philadelphia, PA, USA is $62,000 to $90,000 per year. This may vary based on factors such as experience, education, and the specific company or organization.
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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.
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