Clinical Coding Analyst C&S
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.â 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.â Join us to startâ Caring. Connecting. Growing together. You'll enjoy the flexibility to telecommute from anywhere within the U.S. as you take on some tough challenges. You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear directions on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
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 coderâ with experience working with CPT/HCPCS/ICD - 10/CM/PCSâ coding
- 1+ years of experience working in a team atmosphere in a metric-driven environment including daily production standards and quality standards
Nice To Haves
- 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
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 teams
- Work 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
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Industry
Insurance Carriers and Related Activities
Education Level
High school or GED
Number of Employees
5,001-10,000 employees
