• Job Description

  Req#: 2189223

  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.

  Position in this function review documentation to assure proper application of ICD-10 coding/risk adjustment guidelines and policies are being met. Application of appropriate CPT, CPT II, HCPCS, and modifiers necessary for accurate charge submission and reimbursement. Maintain defined charge submission turnaround times. Query providers for documentation clarification. Communicate with providers and clinic staff on a regular basis regarding documentation, coding and billing related issues.

  If you are located in Arizona, you will have the flexibility to work remotely* as you take on some tough challenges. Preference to have candidates located in Phoenix or Tucson, AZ to be able to train and educate provider teams.

  Primary Responsibilities:

  • Performs concurrent review of provider documentation, diagnoses and charge codes for Medicare Advantage members for assigned providers or sites to ensure proper ICD-10, CPT, CPTII, HCPCS and modifiers are applied
  • Query providers or clinic staff as necessary for clarification of documentation or lack thereof as it pertains to proper application of ICD-10 HCC diagnosis codes
  • Reviews additional chart details and documentation as necessary to ensure proper diagnoses codes are applied; including reviewing orders, pathology, radiology, labs and other test results
  • Identifying/extracting any additional documented HCC diagnosis not coded by provider for reviewed encounter
  • Providing education and coaching to provider teams
  • Will work out of multiple systems including: Touchworks EHR, Allscripts PM and other applications
  • Conducts physician chart audits for HCC coding as requested (includes research and presentation of finding and correct coding principles)
  • Expected to maintain a coding accuracy level of 95%
  • Maintains turnaround times as defined by Manager
  • Assists billing office staff with claims denials and corrections for re-billing purposes as needed
  • Conducts training sessions for physicians on relevant topics or updates, such as documentation guidelines, Medicare/Medicaid regulations, and documentation and coding requirements for HCC/risk adjustment
  • Maintaining current knowledge of coding guidelines and relevant federal regulations through the use of current ICD-10 CM, CPT, and HCPCS II materials
  • Performs other miscellaneous duties

  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 or equivalent
  • Certified Professional Coder (CPC) or (CRC) Certificate
  • 2+ years of experience in physician coding and/or reimbursement activities with HCC coding experience
  • Chart auditing experience
  • Proficient Excel Skills

  Preferred Qualifications:

  • Understanding of CMS risk adjustment model and HCC coding guidelines
  • HCC Certified

  *All employees working remotely 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.

• About the company

  UnitedHealth Group Incorporated is an American multinational managed healthcare and insurance company based in Minnetonka, Minnesota.

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