Surgical Profee Medical Coder

UnitedHealth Group • Albany, NY

88d • $20 - $35 • 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 diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together. Under direction of the Coding Manager, the primary responsibility of the Surgical Profee Medical Coder is to ensure that codes representing current International Classification of Diseases, 9th Revision (ICD-9) or 10th Revision (ICD-10), Current Procedural Terminology (CPT), and the Healthcare Common Procedure Coding System (HCPCS) accurately reflect documented services by applying a demonstrated knowledge of anatomy, physiology and medical terminology as well as compliant coding rules and regulations, including medical necessity and modifiers. Additionally, the Medical Coder serves as the key resource to the Chief and Administrative Director and/or Manager regarding coding changes affecting assigned clinical areas, ongoing coding reviews of providers, and trends associated with coding utilization and optimization, denial management, reimbursement, and customer services issues. The Medical Coder is ultimately responsible for efficient charge capture and reconciliation processes (electronic or paper), knowing and meeting expected targets at sufficient accuracy rates as measured by Transaction Editing System (TES) edits, claim action report volumes, and denials. The Medical Coder will identify potential compliance concerns and/or barriers toward timely completion of all tasks to the Coding Manager and will endeavor to work in collaboration with colleagues in Coding, Clinical Departments, Health Information Management, Information Technology, and Finance toward viable solutions.

Requirements

• High School Diploma/GED (or higher)
• Professional coder certification with credentialing from AHIMA and/or AAPC (RHIA, RHIT, CCS, CCS-P CPC, OR CPC-H) to be maintained annually
• 3+ years of experience in Professional Services Surgery Coding (General Surgery & GI)
• 3+ years of experience working with CPT, HCPCS, ICD-10 codes, anatomy and physiology and medical terminology
• 3+ years of experience working with coding rules and regulations for issues regarding medical record documentation, compliance and reimbursement, including medical necessity, claims denials, bundling issues and charge capture

Responsibilities

• Review charge capture documents, paper or electronic, for completeness and accuracy
• Reconcile collection of charges to daily census report or schedules depending on place of service
• Accurately indicate and link all ICD-10 diagnosis codes, procedure codes and modifiers on the charge document
• Prepare daily charge capture documents according to Bassett policies and procedures
• Process all pre-billing edits on a daily basis and complete each edit within 2 business days
• Ensure charges are posted within the following time lines: 4 days from date of service for Outpatient services and 7 days from date of service for Inpatient services by monitoring Lag Time Reports and working with practitioners and associated staff responsible for charge capture to meet those goals
• Process denials on a daily basis ensuring all requested timelines are met
• Ensure procedure and ICD-10 codes reflect documentation
• Respond to customer service questions and report recurring issues to management
• Work and communicate in a positive, cooperative manner with patients and their families when resolving customer service issues based on management observation and/or patient feedback
• Attend all staff meetings
• Maintain current Coding Certification and active membership in local AAPC chapter, including participation in local events and meetings
• Have a good working knowledge of all hospital computer systems and coding tools available to assist with correct coding
• Keep abreast of coding changes and reimbursement reporting requirements and raise concerns to Coding Manager for resolution
• Review and implement changes to departmental/site clinic sheets and charge documents to reflect current ICD-9 or ICD-10 in October, HCPCS and CPT's in January
• Abide by Standards of Ethical Coding as set forth by the AAPC or AHIMA and adhere to Official Coding Guidelines as set forth by CMS and the OIG
• Conduct annual and focused reviews
• Use interpersonal skills effectively to build and maintain cooperative working relationships with all levels and departments within the organization
• Assist with the orientation, skill development and mentoring of employees new to the coding function
• Provide education to all providers within given specialty based on coding trends and will conduct new provider orientation
• Perform similar or related duties as requested or directed

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