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Form of workYou'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
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 OptumHealth Behavioral Solutions (OHBS) PNI Coding Quality Analyst is responsible for coding and auditing services specific to administrative fraud, waste and abuse cases. This includes the analysis, documentation, explanation and translation of medical and behavioral diagnosis and procedures. The Medical Coder/Analyst will support the OHBS PNI in research, issues and inquires that relate to their reviews and policies on Medical Coding/Auditing.
This position is full-time. Employees are required to work any of our 8-hour shift schedules and can start between 7:00am/8:00am - 5:00pm with some flexibility. It may be necessary, given the business need, to work occasional overtime.
We offer weeks of on-the-job training. The hours during training will be 8-hour shift schedules and can start between 7:00am/8:00am to 5:00pm, Monday - Friday. Training will be conducted virtually from your home.
*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.
Primary Responsibilities
- Conducts reviews on records that have been identified as suspicious and/or potentially fraudulent, utilizing most current reference materials to include, but not limited to: Current Procedural Terminology (CPT), Internal Classification of Disease (ICD-9/ICD 10) and Healthcare Common Procedure Coding System (HCPCs) guidelines
- Documents Decisions on reviews through notations and enters notes in appropriate company systems
- Ability to discuss and present on decisions made to appropriate internal and external individuals/groups
- Coordinate with team members to understand trends and schemes related to billing issues/coding trends
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 GED
- Must be 18 years of age OR older
- Certified Coder AHIMA (CCS, CCS-P, RHIT) or AAPC Certified coder (CPC)
- 3 years of coding experience in CPT medical coding / auditing or coding review for quality assurance
- Ability to work full-time. Employees are required to work any of our 8-hour shift schedules and can start between 7:00am/8:00am - 5:00pm with some flexibility. It may be necessary, given the business need, to work occasional overtime.
Preferred Qualifications:
- Behavioral Health experience
- Strong knowledge of CMS 1500 and UB04 data elements
- Encoder Pro familiarity
Telecommuting Requirements:
- Ability to keep all company sensitive documents secure (if applicable)
- Required to have a dedicated work area established that is separated from other living areas and provides information privacy.
- Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service.
Soft Skills:
- Strong oral and written communication skills
- Physical Requirements and Work Environment: frequent speaking, listening using headset, sitting, use of hands/fingers across keyboard.
- Strong organizational/time management skills and be able to work independently or as a team
- Ability to meet production unit standards while engaging in multiple priorities
- Problem solving skills
California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Washington or Rhode Island Residents Only: The hourly range for California / Colorado / Connecticut / Hawaii / Nevada / New York / New Jersey / Washington / Rhode Island residents is $19.47 - $38.08 per hour. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you'll find a far-reaching choice of benefits and incentives.
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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