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.
The Medical Coder is responsible for reviewing medical records and coding auditing the services provided. This includes the analysis and translation of medical and clinical diagnoses, procedures, injuries, or illnesses into designated numerical codes.
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This is a hybrid position which requires to work in-office Tuesday and Thursday.
Location: 5130 Sunforest Dr. Tampa, FL
Primary Responsibilities:
- Reviewing medical records and documents to abstract clinical data for HEDIS reporting
- Leverage understanding of disease process to identify and extract relevant details and data within clinical documentation and make determinations or identify appropriate medical codes
- Utilize resources and reference materials (e.g., on-line sources, manuals) to identify appropriate medical codes and reference code applicability, rules, and guidelines
- Apply understanding of relevant medical coding subject areas (e.g., diagnosis, procedural, evaluation and management, ancillary services) to assign appropriate medical codes
- Apply understanding of basic anatomy and physiology to interpret clinical documentation and identify applicable medical codes
- Identify areas in clinical documentation that are unclear or incomplete and generate queries to obtain additional information
- Follow up with providers as necessary when responses to queries are not provided in a timely basis
- Utilize medical coding software programs or reference materials to identify appropriate codes
- Read and interpret medical coding rules and guidelines to make decisions (e.g., exclusions, sequencing, inclusions)
- Assist with ensuring that the medical record collection, review, and abstractions are complete and compliant in accordance with NCQA HEDIS technical specifications and guidelines
- Apply post-query response to make final determinations
- Make determinations on medical charting and take initiative to complete reviews independently to avoid delays in the process
- Apply relevant Medical Coding Reference, Federal, State, and Professional guidelines to assign and record independent medical code determinations
- Manage multiple work demands simultaneously to maintain relevant productivity and turnaround time standards for completing medical records (e.g., charts, assessments, visits, encounters)
- Resolve medical coding edits or denials in relation to code assignment
- Apply understanding of National Correct Coding Edits to the coding process
- Demonstrate understanding of National and Local coverage determinations
- Demonstrate basic knowledge of the impact of coding decisions on revenue cycle
- Follow relevant professional code of ethics consistent with required certifications
- Attain and/or maintain relevant professional certifications and continuing education seminars as required
- Leverage relevant computer software programs (e.g., Microsoft Office) to record information, analyze data, or communicate with others
- Utilize and navigate across clinical software applications to assign medical codes or complete reviews
You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:
- High School Diploma/GED (or higher)
- Active AAPC CPC-A (Certified Professional Coder Apprentice) Certification, AHIMA CCA (Certified Coding Associate) Certification
- 2+ years of medical coding experience
- Ability to work in Office Tuesdays and Thursdays
Preferred Qualifications:
- Active AAPC CRC (Certified Risk Adjustment Coder) or CPC (Certified Professional Coder) Certification
- Experience in a managed care health services environment
- Demonstrated knowledge of data collection, medical record review, and data extraction
- NCQA and HEDIS experience
*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.
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.
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.
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