Clinical Coding Analyst C&S

UnitedHealth Group • Plymouth, MN

117d • $23 - $41 • Remote

About The Position

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.

Requirements

• 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
• Intermediate level of experience/knowledge with Microsoft & Adobe applications (Outlook, Power Point, Word, Excel, OneNote, Teams, PDF)

Nice To Haves

• 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

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
• Includes 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
• Performs 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
• Participates 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 team
• Works with applicable business partners to obtain additional information relevant to the clinical review

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Industry: Insurance Carriers and Related Activities
• Education Level: High school or GED