Utilization Management RN Coder

UnitedHealth Group•Newtown Township, PA

1d•$60,200 - $107,400•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. The Utilization Management RN Coder will accurately and efficiently review and extract pertinent case details from patient medical records; and craft strongly defensible appeal letters per process instructions and the department’s/company’s guidance. They will have a working knowledge encoder use and selecting appropriate, supportable appeal arguments from evidence-based, peer reviewed medical literature as provided, as well as interpreting and utilizing ICD 9 and 10, CM and PCS, CPT coding system, and HCPCS guidelines. They will recommend changes to coding which will retain, lessen, or increase financial impact when analysis of chart indicates opportunities. They will educate clients on correct coding and compliance for best practices. They will participate in ALJ (Administrative Law Judge) hearings as representatives of the clients during tele-hearings. The Coding Quality Analyst will complete their case within the time expectations while providing high quality reviews. The Appeals nurse will perform their job functions, adhering to both Optum and OPAS policies and procedures, which include but are not limited to the following: You’ll enjoy the flexibility to telecommute from anywhere within the U.S. as you take on some tough challenges.

Requirements

Associate’s Degree (or higher)
Possess one of the following Coding Certifications: CCS, CCS-P, CPC-H, CPC, RHIT, RHIA, CDIP, CCDS
Unrestricted RN license required in state of residence
3+ years of experience in ED, Telemetry, CCU

Nice To Haves

Pre-authorization experience
Utilization Management experience
Case Management experience
Knowledge of Milliman Criteria
Certified Case Manager (CCM)
All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

Responsibilities

Adheres to approved schedule and arrives to work timely
Maintains accurate accounts of time off in both Verint and HR Direct as per guidelines, and follows directives for time off, schedule changes, etc.
Follows directive of composing appeal letters to include appropriate data extraction, construction of well-written appeals letters with proper grammar, utilization of appeal tools including pre-constructed templates, and inclusion of appropriate medical literature references
Use and fluency of encoders, coding clinics, ICD-9 and 10 guidelines, CM and PCS, CPT coding system and HCPCS guidelines
Working knowledge of Word
Effective communication skills
Excellent typing skills with a minimum speed of 45/min
Adheres to company policies and procedures as well as policies, procedures and laws
Understands and comply with HIPAA confidentiality requirements
Support and promote OPAS, Optum, and the enterprise goals and mission
Build relationships across Optum, OPAS, OGA and our clients
Collaborate with peers to assure continuity of communication and execution of deliverables as needed
Adheres to quality and productivity expectations
Participate in and contribute to meetings as appropriate
Maintains organization on the team and ensures everyone conducts themselves professionally
Remains up to date with all learning modules, competencies, and state required licenses
Performs other related duties, tasks, and processes as required by leadership
Ability to establish priorities, be self-motivated, work independently, and follow instructions with supervision and structure
Positive attitude and the ability to function as a collaborative team member