Senior Inpatient Acute Edits Medical Coder
About The Position
Optum360, a partnership between Dignity Health and Optum and part of UnitedHealth Group, provides revenue management services to health care providers. The Senior Inpatient Acute Edits Medical Coder corrects CCI, MUE, and Medical Necessity Edits on accounts across patient types and performs periodic coding. The role ensures coding assignments are accurate, follow applicable coding policies, and are based on documentation in the medical record. It also provides documentation feedback to physicians under the direction of the Coding Operations Manager or Quality Management personnel. This is a remote role available to telecommuters anywhere within the United States. The schedule is full-time, Monday through Friday, during normal business hours of 8:00 a.m. to 5:00 p.m. Occasional overtime or weekend work may be necessary based on business needs.
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, facility, or similar setting.
- At least 2 years of recent working experience with OCE, MUE, and NCCI classification and reimbursement structures.
- Intermediate proficiency using 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 work the stated Monday–Friday schedule, with occasional overtime or weekend work when business needs require it.
- Adherence to UnitedHealth Group’s Telecommuter Policy for telecommuters.
- Pass a drug test before beginning employment.
Nice To Haves
- Experience with OSHPD reporting.
- Experience with encoder systems such as eCAC, 3M, or EPIC.
- Intermediate proficiency with Microsoft Excel.
Responsibilities
- Assign appropriate ICD-10-CM and ICD-10-PCS codes for inpatient hospital services, understanding their impact on DRG and CC/MCC classifications and following official and facility coding guidelines.
- Assign appropriate CPT and ICD-10 codes for outpatient surgery, observation, emergency, and ancillary services in accordance with official and facility coding guidelines.
- Understand Medicare Ambulatory Payment Classification (APC) codes.
- Abstract additional data elements during chart review when needed.
- Follow coding ethical standards established by AAPC and/or AHIMA.
- Meet and maintain Optum360 coding quality and productivity requirements.
- Provide documentation feedback to providers and query physicians when appropriate.
- Maintain current coding knowledge by reviewing materials recommended or distributed by quality and coding leadership.
- 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.
- Equity stock purchase program.
- 401(k) contribution, subject to eligibility requirements.
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Career Level
Senior
Education Level
High school or GED
