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
UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.
We are committed to introducing innovative approaches, products and services that can improve personal health and promote healthier populations in local communities. Our core capabilities... in clinical care resources, information and technology uniquely enable us to meet the evolving needs of a changing health care environment as millions more Americans enter a structured system of health benefits and we help build a stronger, higher quality health system that is sustainable for the long term.
We serve our clients and consumers through two distinct platforms:
?UnitedHealthcare, which provides health care coverage and benefits services.
?Optum, which provides information and technology-enabled health services.