Coding Quality Auditor - IVR & SDS Observation

About this role

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: Perform comprehensive and specialty-specific audits of medical records to verify coding accuracy and documentation completeness, ensuring compliance with CPT, ICD 10, HCPCS, and organizational coding policies Execute focused reviews and ongoing monitoring projects based on risk indicators or identified trends Confirm that coding practices align with federal, state, and payer regulations including Medicare, Medicaid, HIPAA, and CMS guidelines Interpret and apply corporate and regulatory policies; assist in developing and updating audit-related procedures Track and document audit outcomes thoroughly, including methodology, results, corrective actions, and ongoing monitoring Investigate and identify trends, risk-prone areas, and coding issues like upcoding, under coding, unbundling, or modifier misuse Report audit outcomes, trends, and risks to senior compliance leadership (e.g., Chief Compliance Officer) and other stakeholders Prepare periodic reports (monthly, quarterly, annually), summarizing audit metrics, risk exposure, and remediation efforts 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, polici

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