Senior Inpatient Acute Edits Medical Coder
About The Position
Optum360, a partnership of Dignity Health and Optum within UnitedHealth Group, provides revenue management services to health care providers. The Certified Senior Inpatient Acute Edits Medical Coder works remotely to correct CCI, MUE, and Medical Necessity Edits across accounts for all patient types, in addition to periodic coding. The coder ensures assignments are accurate, follow applicable coding policies, and are supported by medical-record documentation. The role uses knowledge of coding policies and procedures, medical terminology, and technology to provide documentation feedback to physicians under the direction of the Coding Operations Manager or Quality Management personnel. This is a full-time remote position available from anywhere in the U.S. The schedule is Monday through Friday during normal business hours, 8:00 a.m. to 5:00 p.m. Occasional overtime or weekend work may be necessary based on business needs. The role requires adherence to UnitedHealth Group’s Telecommuter Policy.
Requirements
- High school diploma or GED.
- Professional coder certification credentialed by AHIMA and/or AAPC, such as CCS, RHIA, RHIT, CIC, ROCC, CPC, COC, or CPC-P; certification must be maintained annually.
- At least 3 years of recent inpatient medical coding experience using ICD-10-CM/PCS and DRG in a hospital or facility setting.
- At least 2 years of recent working experience with OCE, MUE, and NCCI classification and reimbursement structures.
- Intermediate proficiency with a PC in a Windows environment, including MS Excel and EMR systems.
- Intermediate experience working in a Level I trauma center and/or teaching hospital, with mastery of complex procedures, major trauma ER encounters, cardiac catheterization, interventional radiology, orthopedic and neurology cases, and observation coding.
- Ability to adhere to UnitedHealth Group’s Telecommuter Policy.
- Pass a drug test before beginning employment.
Nice To Haves
- Experience with OSHPD reporting.
- Experience with encoder systems such as eCAC, 3M, and EPIC.
- Intermediate proficiency with Microsoft Excel.
Responsibilities
- Assign appropriate ICD-10-CM and ICD-10-PCS codes for inpatient hospital services, considering DRG impact and CC/MCC, and follow official and facility-specific coding guidelines.
- Assign appropriate CPT and ICD-10 codes for outpatient surgery, observation, emergency, and ancillary services, following official and facility-specific coding guidelines.
- Apply knowledge of Medicare Ambulatory Payment Classification (APC) codes.
- Abstract additional data elements during chart review when needed.
- Follow ethical coding standards established by AAPC and/or AHIMA.
- Meet and maintain coding quality and productivity standards established by Optum360.
- Provide documentation feedback to providers and query physicians when appropriate.
- Maintain current coding knowledge using materials shared or recommended by quality and coding management.
- Participate in coding department meetings and educational events.
- Maintain records of charts coded, held, and/or missing.
- Perform additional responsibilities as identified by the manager.
Benefits
- Comprehensive benefits package, subject to eligibility requirements.
- Incentive and recognition programs, subject to eligibility requirements.
- Equity stock purchase, subject to eligibility requirements.
- 401(k) contribution, subject to eligibility requirements.
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What This Job Offers
Job Type
Full-time
Career Level
Senior
Education Level
High school or GED
