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.
Provides timely and accurate administrative and clinical data through the accurate assignment of current ICD-10-CM/PCS, CPT or HCPCS codes while complying with the regulations and requirements of the Federal Government, State licensing agencies and Optum's policies and procedures.
Primary Responsibilities:
- Assigns the correct ICD-10-CM, ICD-10-PCS, CPT or HCPCS codes to each diagnosis and operative procedure substantiated by documentation contained in the medical record utilizing the current code sets
- Follows departmental and current official coding guidelines to ensure consistent and accurate coding of diagnostic and procedural data
- Utilizes the provided tools and any other necessary applications for proper coding, ensuring accuracy
- Ensures that the medical staff documents have sufficient information for accurate coding and follows the predefined process for notifying management and data science teams when information is incomplete
- Determines the sequence of diagnoses according to UHDDS (Uniform Hospital Discharge Data Set) standards for facility and also properly linking diagnosis to procedures based on the rules for ambulatory/professional coding policies
- Ensures that Optum's policies and procedures for maintenance of medical records encounter details are followed. Maintains current knowledge of coding principles and guidelines as coding conventions are updated
- Maintains a 95% coding accuracy rate
- Performs all other coding/annotating and auditing project related duties as assigned
- Comply with the terms and conditions of the employment contract, company policies and procedures, and any and all directives (such as, but not limited to, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regards to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment). The Company may adopt, vary or rescind these policies and directives in its absolute discretion and without any limitation (implied or otherwise) on its ability to do so
Required Qualifications:
- Certified Coding Specialist (CCS), or Certified Coding Specialist-Physician-based (CCS-P), or Certified Professional Coder (CPC), or Certified Inpatient Coder (CIC) or Certified Outpatient Coder (COC), or Certified Professional Medical Auditor (CPMA)
- 7+ years of acute care hospital inpatient coding/auditing experience, including IP coding, IP DRG/MS-DRG assignment and validation, or ambulatory professional coding/auditing ED/E&M, experience applicable to the specialty in scope
- Knowledge of:
- Current ICD-10-CM, ICD-10-PCS, CPT and HCPCS Level II codes and guidelines;
- Proper sequencing rules; and
- Medical terminology
- Proven ability to:
- Assign appropriate codes based on medical information;
- Maintain medical code databases to ensure accuracy;
- Organize tasks to ensure the timely and accurate coding of information;
- Communicate effectively, both orally and in writing;
- Read, analyze and interpret, governmental regulations, coding support references and coding guidelines;
- Follow written and verbal instructions; and
- Perform multiple tasks and ensure completion to meet strict deadlines
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.