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 an Inpatient 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 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.
- Apply coding knowledge to analyze/correct CCI Edits and Medical Necessity accounts
- 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 assignment 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
- Professional coder certification with credentialing from AHIMA and/or AAPC (CCS, RHIA, RHIT, CIC, ROCC, CPC, COC, CPC-P) to be maintained annually
- HS Diploma or GED
- 3+ years of Inpatient medical coding experience (hospital, facility, etc.)
- 2+ years of Outpatient Facility Surgery coding experience
- Intermediate knowledge of OCE, MUE and NCCI classification and reimbursement structures
- 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
- Must have ICD-10 and DRG coding experience
- Ability to use a PC in a Windows environment, including MS Excel and EMR systems
- Must have access to a home office and high speed cable or DSL internet connection
- Experience with OSHPD reporting
- Experience with various encoder systems (eCAC,3M, EPIC)
- Intermediate level of experience with Microsoft Excel
Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer 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.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.