Senior Inpatient Acute Edits Medical Coder

UnitedHealth Group•Eden Prairie, MN

8d•$24 - $43•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. Delivering quality care starts with ensuring our processes and documentation standards are being met and kept at the highest level possible. This means working behind the scenes ensuring a member-centric approach to care. As a Certified Sr. (IP) Acute Edits Medical Coder you will determine and record the correct medical codes for all treatments and health services. Ensuring proper records is just one way your work will impact on the health and wellness of our members on a huge scale. Who are we? We're Optum360. We're a dynamic new partnership formed by Dignity Health and Optum to combine our unique expertise. As part of the growing family of UnitedHealth Group, we’ll leverage our compassion, our talent, our resources, and experience to bring financial clarity and a full suite of revenue management services to health care providers nationwide. As a Certified Sr. (IP) Acute Edits Medical Coder you will work remotely to correct CCI, MUE, and Medical Necessity Edits on accounts of all patient types in addition to periodic coding. You will ensure that all coding assignments are accurate according to coding policies and based on the documentation provided in the medical record. Using a thorough knowledge of coding policies and procedures as well as medical terminology and technology, you will be responsible for providing documentation feedback to physicians under the direction of the Coding Operations Manager or Quality Management personnel.

Requirements

High School Diploma/GED
Professional coder certification with credentialing from AHIMA and/or AAPC (CCS, RHIA, RHIT, CIC, ROCC, CPC, COC, CPC-P) to be maintained annually
3+ years of recent inpatient medical coding experience with ICD-10-CM/PCS & DRG (hospital, facility, etc.)
2+ years of recent working experience with OCE, MUE and NCCI classification and reimbursement structures
Intermediate level of proficiency with a PC in a Windows environment, including MS Excel and EMR systems
Intermediate level of experience working in a level I trauma center and/or teaching hospital with a mastery of complex procedures, major trauma ER encounters, cardiac catheterization, interventional radiology, orthopedic and neurology cases, and observation coding

Nice To Haves

Experience with OSHPD reporting
Experience with various encoder systems (eCAC,3M, EPIC)
Intermediate level of proficiency with Microsoft Excel

Responsibilities

Identify appropriate assignment of ICD-10-CM and ICD-10-PCS Codes for inpatient services provided in a hospital setting and understand their impact on the DRG with reference to CC/MCC, while adhering to the official coding guidelines and established client coding guidelines of the assigned facility
Identify appropriate assignments of CPT and ICD-10 Codes for outpatient surgery, observation, emergency, and ancillary services while adhering to the official coding guidelines and established client coding guidelines of the assigned facility
Understand the Medicare Ambulatory Payment Classification (APC) codes
Abstract additional data elements during the Chart Review process when coding, as needed
Adhere to the ethical standards of coding as established by AAPC and/or AHIMA
Adhere to and maintain required levels of performance in both coding quality and productivity as established by Optum360
Provide documentation feedback to providers and query physicians when appropriate
Maintain up-to-date Coding knowledge by reviewing materials disseminated/recommended by the QM Manager, Coding Operations Managers, and Director of Coding/Quality Management, etc.
Participate in coding department meetings and educational events
Review and maintain a record of charts coded, held, and/or missing
Additional responsibilities as identified by manager