Position Description: Energize your career with one of Healthcare's fastest growing companies. You dream of a great career with a great company - where you can make an impact and help people. We dream of giving you the opportunity to do just this. And with the incredible growth of our business, it's a dream that definitely can come true. Already one of the world's leading Healthcare companies, UnitedHealth Group is restlessly pursuing new ways to operate our service centers, improve our service levels and help people lead healthier lives. We live for the opportunity to make a difference and right now, we are living it up. This opportunity is with one of our most exciting business areas: Optum - a growing part of our family of companies that make UnitedHealth Group a Fortune 6 leader. Optum helps nearly 60 million Americans live their lives to the fullest by educating them about their symptoms, conditions and treatments; helping them to navigate the system, finance their healthcare needs and stay on track with their health goals. No other business touches so many lives in such a positive way. And we do it all with every action focused on our shared values of Integrity, Compassion, Relationships, Innovation and Performance. 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 Team Lead 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:Ability to solve complex problems and develop innovative approachesServes as a key resource and provide explanations on complex and / or critical issuesSought out as an expert related to coding and clinical reviewAnticipates customer needs and proactively develops solutions to meet themResearch and respond to escalated inquiriesTraining and orientation of new employees on processes and databasesMaintain training materials for team functionsContinual assessment of training needs of seasoned employees and coordination with training team on additional needs outside of departmentFacilitate weekly certified coder meeting to address questions and share updatesDevelop and enhance departmental documentation (Job Aides, P&P's, etc.)Monitor turnaround time actions and assure information is shared with manager if expectations are not going to be metMotivates and inspires other team membersContribute ideas / suggestions for process improvements and automation
Required Qualifications:High School Diploma / GEDRN or Certified Coder5+ years of CPT and ICD-9 Coding1+ years of ICD-10 Coding4+ years of experience within the health insurance claims industryKnowledge of ICD-10 CM and Evaluation Management CodingKnowledge of Diagnosis Related Groups (DRG)Knowledge in Health Information Systems and Coding and Abstracting SystemsKnowledge and experience with Electronic Medical Records (EMR) System and the content of electronic medical recordsIntermediate proficiency with Microsoft Office products: Microsoft Excel (pivot tables and macros), Microsoft Word (creating, editing and, saving), and Microsoft PowerPoint (creation and presentation)Experience creating job policy and procedure documentationExperience with database use and data manipulation Soft Skills:Ability to develop collaborative client relationships Excellent negotiation / influence, collaboration, and listening skillsExcellent communication and problem-solving skillsAbility to quickly assimilate new ideas and concepts and apply them in new situationsEffective presentation and writing skillsCareers 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. 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.Keywords: recovery, resolution, consultant, inpatient, outpatient, claims, Optum, UnitedHealth Group, United Healthcare
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.