Clinical Coding Quality & Education Specialist

NHSHP; Bangor, Northern (ME, KY); Hybrid; USD 40,000 - 72,000; Full time

Benefits offered by this job

Comprehensive benefits

Incentive and recognition programs

Equity stock purchase plan

401k contribution

Job summary

Optum is seeking a physician coding specialist to serve as a liaison between coding teams and providers, ensuring accurate documentation and coding across multiple specialties. The role includes delivering education, audits, and guidance to physicians, coders, and staff.

The ideal candidate has 3+ years of physician coding experience (ICD-10, CPT, HCPCS II) in a teaching hospital setting with surgical E/M coding and strong knowledge of MUE/NCCI.

Qualifications

• High School Diploma or GED required.
• AHIMA and/or AAPC coding certification (CPC, CCS-P, RHIA, RHIT) maintained annually.
• 3+ years of Physician medical coding (ICD-10, CPT, HCPCS II) experience in a multi-specialty physician clinic.
• 2+ years of Residency Program experience with surgical coding in E/M and multiple specialties.
• 2+ years of experience providing expert coding guidance to physicians, practitioners, and coders.
• Intermediate knowledge of MUE and NCCI classification and reimbursement structures.
• Intermediate proficiency in Windows, MS Excel, and Epic.

Responsibilities

• Serve as liaison between coding teams and providers to resolve inquiries and concerns.
• Collaborate with Edits and Denials teams to analyze trends and address recurring issues.
• Partner with clinical leadership during introduction of new services to ensure accurate documentation and coding compliance.
• Participate in quarterly specialty/physician group meetings to provide targeted coding education and respond to inquiries.
• Deliver comprehensive coding and documentation training for all newly onboarded providers.
• Provide annual education to providers on code set updates to maintain compliance and accuracy.
• Conduct annual provider audits to validate charges and supporting documentation and identify revenue opportunities.
• Provide targeted education and follow-up audits for providers who do not meet established quality standards.
• Perform ad hoc audits in response to client requests or identified concerns.
• Educate coders and providers on audit findings and emerging trends to promote continuous improvement.
• Assist coders/supervisors with rebuttals for tri-annual audits.

Skills

Physician medical coding

MUE & NCCI knowledge

MS Excel

Epic

Communication skills

Medical education

Education

High School Diploma or GED

AHIMA/AAPC coding certification (CPC, CCS-P, RHIA, RHIT)

Tools

Epic

Encoder Pro

Microsoft Teams

Job description

Optum is seeking a physician coding specialist to serve as a liaison between coding teams and providers, ensuring accurate documentation and coding across multiple specialties. The role includes delivering education, audits, and guidance to physicians, coders, and staff.

The ideal candidate has 3+ years of physician coding experience (ICD-10, CPT, HCPCS II) in a teaching hospital setting with surgical E/M coding and strong knowledge of MUE/NCCI.