Coding Specialist 1

OVERVIEW OF THE POSITION: Responsible for participating in the implementation of the organization’s Coding Proficiency program. Performs medical chart audits for Evaluation and Management and ICD-10 coding and documentation. Interfaces and disseminates audit results to clinicians and management. ESSENTIAL FUNCTIONS: • Performs medical chart audits meeting minimum productivity standards. • Educates clinicians on specific coding issues found in senior HMO pre-audits. • Submits and follows up on query forms to clinicians based on “inferred” chart audit data. • Submits weekly audit totals to Coding management. • Performs claims analysis for appropriate CPT and ICD-10 coding. • Identifies CPT unbundling in claim submissions. • Uses coding knowledge to work the claim system edits. • Performs Coding analysis of claims denials. • Reviews TES edits for coding analysis. • Works with Claims management and IPA / contracted clinicians on claim edit resolution. • Stays abreast of industry coding and compliance issues. • Participates in coding / auditing discussions to ensure best practice efforts and processes are implemented ensuring maximum reimbursement through appropriate coding. • Attends Coding program monthly meetings. • Uses, protects, and discloses Optum patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards. • Performs additional duties as assigned. EDUCATION: • One or two years of post-high school education or a degree from a two-year college. • Coding certification through AAPC or AHIMA required. EXPERIENCE: Minimum: • Over 1 year and up to 3 years of experience of ICD9, CPT and HCPCS coding experience or successful completion of Coding Program internship. Preferred: • 3 years medical billing or health care experience. • IDX BAR experience. • Allscripts / Enterprise experience. • Clinical experience. KNOWLEDGE, SKILLS, ABILITIES: • Computer literate with medical billing software. • Proficient in Word, Excel, PowerPoint, Multi-media projector. • Knowledge of CMS coding guidelines. • Excellent verbal and written communication skills in the English language. • Must be able to work independently to carry out work efforts. • Bilingual / Spanish preferred. • You will be asked to perform this role in an office setting or other company location, however, may be required to work from home temporarily due to space limitations. UnitedHealth Group requires all new hires and employees to report their COVID-19 vaccination status. Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Here you’ll find incredible ideas in one incredible company and a singular opportunity to do your life's best work. (SM) Diversity creates a healthier atmosphere: Optum and its affiliated medical practices are Equal Employment Opportunity/Affirmative Action employers and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. Optum and its affiliated medical practices is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. Apply tot his job Apply To this Job