Edits/Denials Coder

Optum; Eden Prairie (MN); On-site; USD 50,000 - 90,000; Full time

Benefits offered by this job

Remote work

Comprehensive benefits package

401k contribution

Job summary

UnitedHealth Group is seeking a Senior Ambulatory Medical Coder Edits to accurately determine CPT and ICD-10 Edits for Professional Services. Remote 40-hour weeks, with shifts across eight hours, and flexibility to telecommute from anywhere in the U.S.

You will provide documentation feedback to physicians and ensure coding aligns with official guidelines, LCD/NCD policies, and payer requirements under the Coding Operations Manager or QM personnel.

Qualifications

• High School Diploma or GED required.
• Professional coder certification with AHIMA and/or AAPC (CCA, CCS, RHIA, RHIT, CPC-H/COC, CIC, CCS-P, CPC, CPC-A) maintained annually.
• 2+ years of Professional/Ambulatory coding experience for all chart types (Surgery, ED, clinics).
• 1+ years of experience with LCD/NCD, Medical Necessity, Modifier Edits, OCE, MUE and NCCI structures.
• 1+ years of experience with coding payer denials.
• Expert proficiency in CPT and ICD-10-CM coding.
• Ability to use a PC in Windows, MS Excel and EMR systems.

Responsibilities

• Identify CPT and ICD-10 Edits for Professional Services following official guidelines.
• Analyze/correct CCI Edits and Medical Necessity accounts.
• Adhere to coding ethics per AAPC/AHIMA.
• Maintain performance standards in coding quality and productivity.
• Provide documentation feedback to providers and query physicians when needed.
• Keep coding knowledge up-to-date via QM/Director communications.
• Participate in coding department meetings and training.
• Handle additional responsibilities as assigned.

Skills

CPT coding

ICD-10-CM

AHIMA/AAPC certification

MS Excel

EMR systems

Medical terminology

Payer denials

CCI Edits

Medical Necessity

Education

High School Diploma/GED

Tools

EPIC

Encoder

Job description

Improve the lives of others while Caring. Connecting. Growing together.

Job Description - Edits/Denials Coder (2380676)

Edits/Denials Coder - 2380676

Optumis 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 startCaring. Connecting. Growing together.

As anSenior Ambulatory Medical Coder Editsyou will work remotely to accurately determine CPT and ICD-10 Edits for all types of Professional Coding Services. You will ensure that all coding assignments are accurate according to coding policies and based on the documentation provided in the medical record. Using a thorough knowledge of coding policies and procedures as well as medical terminology and technology, you will be responsible for providing documentation feedback to physicians under the direction of the Coding Operations Manager or Quality Management personnel.

This position is full-time (40 hours/week)Monday-Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules.

You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities

• Identify appropriate assignments of CPT and ICD-10 Edits for Professional Services while adhering to the official coding guidelines and established client coding guidelines of the assigned facility
• Apply coding knowledge to analyze/correct CCI Edits and Medical Necessity accounts
• Adhere to the ethical standards of coding as established by AAPC and/or AHIMA
• Adhere to and maintain required levels of performance in both coding quality and productivity as established by Optum360
• Provide documentation feedback to providers, as needed, and query physicians when appropriate
• Maintain up-to-date coding knowledge by reviewing materials disseminated / recommended by the QM Manager, Coding Operations Managers, and Director of Coding / Quality Management, among others
• Participate in coding department meetings and educational events
• Additional responsibilities as identified by manager

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/GED
• Professional coder certification with credentialing from AHIMA and/or AAPC (CCA, CCS, RHIA, RHIT, CPC-H/COC, CIC, CCS-P, CPC, and CPC-A) to be maintained annually
• 2+ years of Professional/Ambulatory coding experience for all chart types, Same Day Surgery, Observation, Emergency Department, Ancillary services, and Clinics
• 1+ years of experience working with LCD, NCD, Medical Necessity, Modifier Edits, OCE, MUE and NCCI classification and reimbursement structures
• 1+ years of experience working with coding payer denials
• Expert level ofproficiencyin CPT and ICD-10-CM coding
• Ability to use a PC in a Windows environment, including MS Excel and EMR systems

Preferred Qualifications

• Experience with various encoder systems (Encoder, EPIC)

Telecommuting Requirements

• Required to have a dedicated work area established that is separated from other living areas and provides information privacy
• Ability to keep all company sensitive documents secure (if applicable)
• Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you’ll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $24.00 to $43.00 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

Application Deadline

This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

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.

UnitedHealth Group is committed to working with and providing reasonable accommodations to individuals with physical and mental disabilities. If you need special assistance or accommodation for any part of the application process, please call 1-866-566-8715 to be connected to Recruitment Services. Recruitment Services hours of operation are 7 a.m. to 7 p.m. CT, Monday through Friday.

UnitedHealth Group is a registered service mark of UnitedHealth Group, Inc. The UnitedHealth Group name with the dimensional logo, as well as the dimensional logo alone, are both service marks for the UnitedHealth Group, Inc.

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.