Outpatient Medical Coder Edits

Outpatient Medical Coder Edits

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 diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

As an Outpatient Medical Coder Edits you will work remotely to accurately determine CPT and ICD-10 Codes for all types of same day surgeries, major Trauma ER encounters, observations, and complex surgery cases including orthopedic and spinal fusions. You will ensure that all coding assignments are accurate according to coding policies and based on the documentation provided in the medical record. Using a thorough knowledge of coding policies and procedures as well as medical terminology and technology, you will be responsible for providing documentation feedback to physicians under the direction of the Coding Operations Manager or Quality Management personnel.

This position is full-time (40 hours/week) Monday-Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules.

You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Identify appropriate assignments of CPT and ICD-10 Codes for outpatient surgery, observation, CVIR, emergency, and ancillary services while adhering to the official coding guidelines and established client coding guidelines of the assigned facility
• Apply coding knowledge to analyze/correct CCI Edits and Medical Necessity accounts
• Understand the Medicare Ambulatory Payment Classification (APC) codes
• Abstract additional data elements during the chart review process when coding, as needed
• Adhere to the ethical standards of coding as established by AAPC and/or AHIMA
• Adhere to and maintain required levels of performance in both coding quality and productivity as established by Optum360
• Provide documentation feedback to providers, as needed, and query physicians when appropriate
• Maintain up-to-date coding knowledge by reviewing materials disseminated / recommended by the QM Manager, Coding Operations Managers, and Director of Coding / Quality Management, among others
• Participate in coding department meetings and educational events
• Review and maintain a record of charts coded, held, and / or missing
• Additional responsibilities as identified by manager

Required Qualifications:

• High School Diploma/GED
• Professional coder certification with credentialing from AHIMA and/or AAPC (CCA, CCS, RHIA, RHIT, CPC-H/COC, CIC, CCS-P, CPC, and CPC-A) to be maintained annually
• 2+ years of Outpatient Facility coding experience for all chart types, Same Day Surgery, Observation, Emergency Department, Ancillary services, and Clinics
• 1+ years of experience working with LCD, NCD, Medical Necessity, Modifier Edits, OCE, MUE and NCCI classification and reimbursement structures
• Expert level of proficiency in CPT and ICD-10-CM coding
• Ability to use a PC in a Windows environment, including MS Excel and EMR systems

Preferred Qualifications:

• Experience with complex cardiac catheterizations and interventional radiology (CVIR/IVR)
• Experience with various encoder systems (eCAC,3M, EPIC)
• Experience with OSHPD reporting
• Intermediate level of experience with Microsoft Excel

Telecommuting Requirements:

• Required to have a dedicated work area established that is separated from other living areas and provides information privacy
• Ability to keep all company sensitive documents secure (if applicable)
• Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service

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). The hourly pay for this role will range from $20.00 to $36.00 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

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.