Medical Coder

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

   Primary Responsibilities

 

The coder will evaluate medical records to verify the plan of care for chronic medical conditions

The coder will perform accurate and timely coding review and validation of Hierarchical Condition Categories (HCCs) and Diagnoses through medical records. The coder will document ICD-10-CM codes to verify that coding meets both established coding standards as well as CMS Risk Adjustment Guidelines

The coder will assist the project teams by completing review of all charts in line with Medicare & Medicaid Risk Adjustment criteria

Apply understanding of anatomy and physiology to interpret clinical documentation and identify applicable medical codes

Verify and ensure the accuracy, completeness, specificity and appropriateness of diagnosis codes based on services rendered

Evaluate medical record documentation to ensure coding accurately reflects and supports relevant coding based on the ICD-10 code submitted to CMS for reimbursement and interpretation of medical documentation to ensure capture of all relevant coding based on CMS Hierarchical Condition Categories (HCC)conditions that are applicable to Medicare Risk Adjustment reimbursement initiatives

Demonstrate analytical and problem-solving ability regarding barriers to receiving and validating accurate HCC information

Meet the production targets

Meet the Quality parameters as defined by the Client SLA

Other duties as assigned by supervisors.

Comply with the terms and conditions of the employment contract, company policies and procedures, and any and all directives (such as, but not limited to, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regards to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment). The Company may adopt, vary or rescind these policies and directives in its absolute discretion and without any limitation (implied or otherwise) on its ability to do so

Full-timeYes

Work from officeYes

Travelling Onsite / OffsiteNo

 Required Qualifications

 

Any graduate experience

Graduates in Medical, Paramedical or Life Science disciplines are preferred. Graduates from other disciplines may be considered subject to their ability to demonstrate technical competence in ICD-10 CM and risk adjustment guidelines and standards

AAPC/AHIMA Certification is mandatory (CRC is most preferred followed by CPC, CIC or COC) or AHIMA-CCS certified

Work experience of 1+ years

Medical coding work experience of a minimum of 1 year is required. HCC coding work experience is highly preferred. Experience in other medical coding work experience can be considered provided they demonstrate technical competence in ICD-10 CM and risk adjustment guidelines and standards

Good knowledge in Anatomy, Physiology & Medical terminology

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.