Outpatient Facility Coding Compliance | , |
UnitedHealth Group · Danville, VA
Job description(tap to read)
Outpatient Coding Compliance Auditor 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 andresources 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. The Outpatient Coding Compliance Auditor performs audits of outpatient facility (OPPS) coding to ensure accurate assignment of ICD-10-CM diagnoses, CPT/HCPCS codes, modifiers, and facility E/M levels (ACEP or client-specific). This role reviews coding for alignment with medical record documentation and established guidelines, ensuring compliance with applicable laws, regulations, and billing standards while effectively communicating findings to stakeholders. The Auditor also analyzes audit outcomes to identify trends, determine root causes, and pinpoint opportunities for improvement, as well as assess the effectiveness of corrective actions. Additionally, as part of the Compliance Workplan the Auditor participates in quality assurance (QA) coding oversight, conducts independent reviews, and supports organizational compliance initiatives. You'll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities: • Perform coding compliance and quality audits in support of Optum Insight Provider's Compliance Program and client expectations • Independently analyze and interpret clinical documentation from medical records • Validate coding accuracy for outpatient facility, including E/M services, procedures, and modifiers • Identify audit findings, calculate billing error rates, and perform root cause analysis to determine drivers of non-compliance • Assess and evaluate the adequacy and effectiveness of corrective action plans, providing follow-up validation as appropriate • Clearly document audit findings and articulate results tailored to the appropriate audience • Prepare written audit analysis and summary reports, including compliance risk, trends, and recommended corrective actions • Conduct ad hoc coding and billing audits as requested • Provide compliance oversight of QA audit activities, ensuring consistency and adherence to established standards • Audit vendor coders and auditors, including offshore staff • Monitor and track evolving industry trends, regulatory updates, and government audit activities to identify potential coding and billing risk areas • Stay current with applicable coding, billing, and regulatory guidelines • Research, develop, and present targeted education based on individual, team, and systemic audit findings 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: • Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) or Certified Outpatient Coder (COC) • 5+ years of Outpatient Facility coding experience including: • NCCI/OCE billing edits related to outpatient services coding and billing • ICD-10-CM and CPT (including CPT-4) • ACEP Facility or similar Facility E/M matrix guidelines for outpatient facility code assignment • 5+ years of Outpatient Facility audit experience, including surgery, observation, and emergency department, including: (Strong industry knowledge of Medicare regulations and payment policies, including OPPS) Preferred Qualifications: • Registered Health Information Administrator (RHIA) or Registered Health Information Technician (RHIT) or Certified Professional Medical Auditor (CPMA) a plus • Demonstrated ability to perform independent, autonomous audit and coding review functions • Strong professional communication skills, both oral and written • Ability to prioritize and manage multiple assignments, spreadsheets, documents, and reports • Proven time management skills with consistent follow-through to completion • Proficiency with Microsoft Excel, Teams, PowerPoint, Word, and Outlook Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $72,800 to $130,000 annually based on full-time employment. We comply with all minimum wage laws as applicable. Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records. Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. 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 is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.
Restaurant Delivery
DoorDash · Danville, VA
DoorDash is the #1 category leader in food delivery, food pickup, and convenience store delivery in the US, trusted by millions of customers every day.
Client Service Coordinator
State of Montana · Danville, VA
Client Service Coordinator The Department of Public Health & Human Services is seeking to fill 10 Modified Client Service Coordinator positions at various locations statewide. Applicants may indicate their preferred work location(s) during the application process. These 10 new modified positions are grant funded. It is funded through June 30, 2027. After this date, the position may be funded permanently or may be subject to a reduction in force (RIF). The Client Service Coordinator position serves as a vital customer service role and has direct contact with the general public in-person and via a telephone helpline. This position listens to clients, advises of available assistance and timely processes applications/benefits or advises of further documentation required. This position also interviews clients, interprets policies and procedures, and handles a large caseload with competing priorities in a fast-paced customer service environment. Our mission at DPHHS is to serve Montanans in their communities to improve and protect the health, safety, and well-being, and to empower independence. By joining our department, you will have the opportunity to perform meaningful work in public service to our state and its residents. The State of Montana's comprehensive benefits package includes healthcare coverage, retirement plans, paid vacation, sick leave, and holidays, work/life balance, and eligibility to participate in the Public Service Loan Forgiveness (PSLF) program. In addition, DPHHS is the largest state agency with a wide range of advancement opportunities whether you are joining the workforce or have several years of experience. Knowledge of public assistance programs and eligibility requirements. Knowledge of customer service principles, practices, and positive public relations. Detail oriented, time management, and multitasking skills. Ability to adhere to confidentiality and proper release of information. Meet minimum qualifications: Associate's degree or certificate in communications, office management, business, human services, sociology, psychology, or other field of study AND four years of job-related experience determining or processing eligibility for social programs and/or health, financial loans, unemployment, collections, call center etc. OR Equivalent to graduation from high school AND five years of professional customer service experience to include considerable public contact in a fast-paced environment managing a large workload, solving complex problems, and handling competing priorities while meeting quality standards. OR related bachelor's degree and 2 years job related experience. Salary: $29.30 Hourly Telework Eligibility: Telework Eligible (Full-time telework is not available. Telework schedule must be supervisor approved.) Benefits Package Eligibility: Health Insurance, Paid Leave & Holidays, Retirement Plan Number of Openings: 10 Employee Status: Regular Schedule: Full-Time Job Type: Standard Shift: Day Job Travel: Yes, 5 % of the Time Primary Location: Helena Other Locations: Hardin, Billings, Missoula, Miles City, Kalispell, Polson, Lewistown, Havre, Lame Deer, Wolf Point, Glasgow, Anaconda, Butte, Hamilton, Libby, Bozeman, Great Falls Agency: Department of Public Health & Human Services Union: Montana Federation of Public Employees
Case Management Coordinator (Illinois)
CVS Health · Danville, VA
Case Management Coordinator We're building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Program Overview Help us elevate our patient care to a whole new level! Join our Aetna team as an industry leader in serving dual eligible populations by utilizing best-in-class operating and clinical models. You can have life-changing impact on our members who are enrolled in Medicare and Medicaid and present with a wide range of complex health and social challenges. With compassionate attention and excellent communication, we collaborate with members, providers, and community organizations to address the full continuum of our members' health care and social determinant needs. Join us in this exciting opportunity as we grow and expand to change lives in new markets across the country. Position Summary The Case Management Coordinator utilizes critical thinking and judgment to collaborate and inform the case management process, The Case Management Coordinator facilitates appropriate healthcare outcomes for members by aiding with appointment scheduling, identifying and assisting with accessing benefits and education for members through the use of care management tools and resources. Key Responsibilities • Evaluation of Members: -Through the use of care management tools and information/data review, conducts comprehensive evaluation of referred member's needs/eligibility and recommends an approach to case resolution and/or meeting needs by evaluating member's benefit plan and available internal and external programs/services. • Identifies high risk factors and service needs that may impact member outcomes and care planning components with appropriate referral to clinical case management or crisis intervention as appropriate. • Coordinates and implements assigned care plan activities and monitors care plan progress. • Enhancement of Medical Appropriateness and Quality of Care: Using holistic approach consults with case managers, supervisors, Medical Directors and/or other health programs to overcome barriers to meeting goals and objectives; presents cases at case conferences to obtain multidisciplinary review in order to achieve optimal outcomes. • Identifies and escalates quality of care issues through established channels. • Utilizes negotiation skills to secure appropriate options and services necessary to meet the member's benefits and/or healthcare needs. • Utilizes influencing/ motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health. • Provides coaching, information and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices. • Helps member actively and knowledgably participate with their provider in healthcare decision-making. • Monitoring, Evaluation and Documentation of Care: - Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures. Required Qualifications • Must reside in the state of Illinois • Must possess reliable transportation and be willing and able to travel up to 40% of the time from candidate home location. Mileage is reimbursed per our company expense reimbursement policy • Must have computer literacy in order to navigate through internal/external computer systems, including Excel and Microsoft Word. • Effective communication, telephonic and organization skills • Excellent analytical and problem-solving skills • Ability to work independently • Ability to effectively participate in a multi-disciplinary team including internal and external participants. • 2 years' experience in behavioral health, social services or appropriate related field equivalent to program focus Preferred Qualifications • Case management and discharge planning experience • Managed Care experience • Bilingual Education Bachelor's degree or non-licensed master level clinician required, with either degree being in behavioral health or human services required (nursing, psychology, social work, marriage and family therapy, counseling). Work from Home Requirements: • You must have or be able to obtain a direct/hardwired internet connection to a modem/router within 7 feet of your computer and a minimum download speed of 25 mbs download and 3 mbs upload. WiFi and satellite internet are not permitted. • A quiet, secure and private designated home virtual work location, free from distractions, tidy and organized, compliant with CVS Health and HIPAA guidelines, and allowing for uninterrupted work during work hours. • Work-from-Home colleagues are required to work within the state and city where they have confirmed they currently live. • The company will provide equipment (keyboard, monitor, computer, headset, etc.). All new hires should provide their own workspace furniture (desk or standing desk, as this position would require you to be at your desk for extended periods of time). • If hired, you will commit to obtaining required internet speeds and adhere to all Work From Home requirements. Technical and Logistical Requirements: • Device & System Navigation: Comfortable setting up and using multiple monitors and navigating multiple applications simultaneously to streamline tasks and improve efficiency. • Communication Tools: Ability to communicate on digital channels such as via email, calendar invites, Teams messaging, and virtual meetings. • Collaboration & Scheduling: Experience with Microsoft Office 365 (Teams, Outlook, Word, Excel, PowerPoint) applications or similar (Google Workspace). • Systems Access & Security: Ability to Log in to secure systems (e.g., VPN, EHR portal), lock a computer screen when unattended, manage strong passwords, and recognize suspicious emails or links. • Troubleshooting & Support: Ability to resolve common technical issues independently, such as: restarting an application when frozen, resolving internet connection issues, and contacting IT for unresolved technical issues. • Future Growth: Openness to learning new skills in the future as the workplace environment evolves Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $21.10 - $44.99 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. Additional details about available benefits are provided during the application process and on Benefits Moments. We anticipate the application window for this opening will close on: 08/14/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
Customer Experience Consultant (Remote)
CPJ Recruitment · Danville, VA
About the job Customer Experience Consultant (Remote) We are seeking outgoing individuals for our Customer Experience Consultant (Remote) positions. As an Customer Experience Consultant (Remote), you will work from home coordinating vacation and corporate travelarrangements for clients nationwide and internationally. This opportunity is ideal for individuals who enjoy helping others plan meaningful experiences and are interested in building something flexible around their schedule. ROLES & RESPONSIBILITIES: • Research, create, and coordinate customized itineraries for clients • Review client preferences and budgets to design tailored travel plans • Arrange travel needs including airlines, hotels, car rentals, cruises, tours, and events • Communicate with clients before and after travel to ensure satisfaction • Assist with issues that may arise before, during, or after travel • Complete ongoing training and certifications within the industry • Attend webinars and supplier trainings to stay current on destinations and products • Remain informed on changes within the travel and tourism industry POSITION REQUIREMENTS: • Strong communication skills • Reliable internet access and a computer (recommended) or smartphone • Hospitality, customer service, or sales experience is helpful but not required • Personal travel experience is a plus BENEFITS: • Full training provided • Flexible schedule (full-time or part-time options) • Work from home • Access to travel industry discounts