Clinical Coding Analyst C&S

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.

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

Primary Responsibilities:

• Performs clinical review of CPT, HCPCS, and modifiers assigned to codes on claims in a telecommuting work environment

• Determines accuracy of medical coding/billing and payment recommendation for claims

• This could include Medical Director/physician consultations, interpretation of state and federal mandates, applicable benefit language, medical and reimbursement policies and consideration of relevant clinical information

• Determines appropriate level of service utilizing Evaluation and Management coding principles

• Provides detailed clinical narratives on case outcomes

• Perform claim re-coding (Post Pay only)

• Ensures adherence to state and federal compliance policies, reimbursement policies and contract compliance

• Identifies aberrant billing patterns and trends, evidence of fraud, waste, or abuse, and recommends providers to be flagged for review

• Maintains and manages daily case review assignments, with accountability to quality, utilization, and productivity standards

• Provides clinical support and expertise to the other investigative and analytical areas

• Participate in team and department meetings

• Engages in a collaborative work environment when applicable but is also able to work independently

• Serves as a clinical resource to other areas within the clinical investigative teama

• Work with applicable business partners to obtain additional information relevant to the clinical review

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:

• High School Diploma/GED (or higher)

• Professional coder certification with credentialing from AAPC (CPC-A, CPC, COC, CPC-P) to be maintained annually

• 2+ years of experience as an AAPC Certified coder with experience working with CPT/HCPCS/ICD - 10/CM/PCS coding

• 1+ years of experience working in a team atmosphere in a metric-driven environment including daily production standards and quality standards

Preferred Qualifications:

• Intermediate level of proficiency with Microsoft & Adobe applications (Outlook, Power Point, Word, Excel, OneNote, Teams, PDF)
• Bachelor's degree (or higher)

• Nurse (RN, LPN) with unrestricted and active license/certification 

• Healthcare claims experience/processing experience

• Experience with Fraud Waste & Abuse or Payment Integrity

• Strong medical record review experience

• Knowledge of health insurance business, industry terminology, and regulatory guidelines

• An understanding of Waste & Error principles  

• Strong analytical mindset working with medical terminology or coding

Soft Skills:  

• Highly organized with effective and persuasive communication skills 

• Strong written communication skills 

• Open to change and new information; ability to adapt in changing environments and integrate best practices  

• Physical Requirements and Work Environment: frequent speaking, listening using headset, sitting, use of hands/fingers across keyboard

• Must be proficient and able to navigate and maneuver multiple systems at one time with varying levels of complexity

• Must have strong computer skills with the ability to troubleshoot problems

• Strong communication skills with the ability to interpret data

*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.

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 hourly pay for this role will range from $23.41 to $41.83 per hour 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 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.

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.

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