Position Description:Welcome to one of the toughest and most fulfilling ways to help people, including yourself. We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement. Join us and start doing your life's best work. Positions in this function are responsible for investigating, reviewing, and resolving Professional and / or Facility provider claims on behalf of our commercial and government customers and their health plans. This may include leading as an expert in telephone calls or meetings with providers, clients and other investigative areas. A critical function of this role is ensuring adherence to state and federal compliance policies, reimbursement policies and contract compliance. The Certified Coding Consultant will investigate, review, and provides clinical and / or coding expertise in the application of medical and reimbursement policies within the claim adjudication process through file review. This could include Medical Director / Physician consultations, interpretation of state and federal mandates, applicable benefit language, medical and reimbursement policies and consideration of relevant clinical information. Primary Responsibilities:Perform CPT coding / DRG validations and provide outcomes management for decreasing denied claims. Will compose educational letters to provide information on coding guidelines and regulations support the medical record findings. Assist educators with their coding questions.Required to complete 12 - 15 DRG validations /or 6-8 coding audits per week and provide educational letters on those reviews back to providers.Conduct chart audits to assure claims are paid accurately and contributes to the overall recoveries
RequirementsHigh School Diploma / GED or higher 2+ years experience as a Certified Coder (inpatient and outpatient claims)2+ years of CPT / HCPCS / ICD-9 / ICD-10 coding experience with a thorough knowledge of health insurance business, including knowledge of industry terminology, and regulatory guidelinesAbility to develop collaborative client relationships is requiredMicrosoft Word (creating and editing documents) and Excel (creating and editing spreadsheets, analyzing data, sorting, filtering) experienceAssets:Bachelor's degree (or higher)Healthcare Claims experienceManaged care experienceInvestigational and / or Auditing experienceClient service experience preferredHealthcare and / or project management experience is preferred2+ years of experience as a Manager, Supervisor and / or Team LeadSoft Skills: Excellent negotiation/influence, collaboration, and listening skills.Excellent communication and problem solving skills.Ability to quickly assimilate new ideas and concepts and apply them in new situations.Effective presentation and writing skills Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. 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. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.SMDiversity 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.Keywords: recovery, resolution, consultant, inpatient, outpatient, claims
Our mission is to help people live healthier lives and to help make the health system work better for everyone.- We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities. - We work with health care professionals and other key partners to expand access to quality health care so people get the care they need... at an affordable price. - We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions.