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Job Details

Nurse Coder - Medical Record Review Team




Brentwood, Tennessee, United States

At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us and start doing your life's best work.(sm)

The Nurse Coder reports directly to the Medical Record Review Team. The position is responsible for performing coding and clinical medical record reviews to be utilized in investigations relative to healthcare fraud, waste, and abuse.

If you are located in Tennesse, you will have the flexibility to work remotely* as you take on some tough challenges

Primary Responsibilities:

  • Performs medical record reviews of retrospective medical claims relative to of all types of fraud, waste, and abuse cases, to include all levels of complexity
  • Documents medical review findings on a claim level and drafts reports of findings to be relied on in investigations of fraud, waste, and abuse cases
  • Ensure compliance with the UnitedHealthcare (UHC) Fraud, Waste and Abuse policies and other federal/state regulations or contractual obligations
  • Has the ability to code a variety of medical records using CPT, HCPCS and ICD-10 codes for office, outpatient, inpatient, surgical, hospital ancillary, nursing facility, urgent care, ambulatory surgery center and other charges for physicians and other providers of professional billing
  • Supplies all criteria that was relied on supporting all recommendations for denial or modification of claim payment errors
  • Serves as a clinical resource for team members in the Special Investigations Unit
  • Broad knowledge of medical coding to include using CPT, HCPCS and ICD-10 codes for office, outpatient, inpatient, surgical, hospital ancillary, nursing facility, urgent care, ambulatory surgery center and other charges for physicians and other providers of professional billing
  • Some knowledge and experience in health care fraud, waste, and abuse (FWA) investigations
  • Broad knowledge and experience in state and federal regulatory FWA requirements
  • Excellent computer multi-tasking skills and analytical thought process
  • Demonstrated ability to communicate effectively, to include written and verbal forms of communication
  • Ability to participate in legal proceedings, arbitrations, depositions, etc.

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

Required Qualifications:

  • Bachelor’s degree or Associates degree plus two years of equivalent work experience with healthcare related employment
  • Certified Professional Coder (CPC)
  • Registered Nurse (RN)
  • Advanced level of proficiency in Microsoft Excel and Word

Preferred Qualifications:

  • Specialized knowledge/training in healthcare FWA investigations
  • Active affiliations:
  • National Health Care Anti-Fraud Association (NHCAA)
  • Accredited Health Care Fraud Investigator (AHFI)
  • Certified Fraud Examiner (CFE)

Careers with UnitedHealthcare. Work with a Fortune 5 organization that’s serving millions of people as we transform health care with bold ideas. Bring your energy for driving change for the better. Help us improve health access and outcomes for everyone, as we work to advance health equity, connecting people with the care they need to feel their best. As an industry leader, our commitment to improving lives is second to none.

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

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.

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.