Senior Inpatient Edits/Denials

Optum; Eden Prairie (MN); Remote; USD 33,000 - 59,000; Full time

Job summary

Optum is seeking a qualified coder to assign ICD-10 CM/PCS and DRGs for inpatient facility services, adhering to official guidelines and client-specific rules. The role emphasizes high-quality coding, ethics, and continuous knowledge updates.

You will review charts, query physicians when needed, and participate in departmental meetings. A strong background in inpatient coding and AHIMA/AAPC credentials is required, with telecommuting options within the U.S.

Qualifications

• 3+ years of experience with Inpatient Edits/Denials coding in an acute care facility setting.
• 3+ years of experience with ICD-10-CM, ICD-10-PCS, and DRG coding utilizing an encoder.
• Intermediate level of proficiency working with PC in a Windows environment, including Microsoft Excel and various EMR systems with ease.

Responsibilities

• Identify appropriate assignment of ICD-10 CM, ICD-10-PCS, DRG, and abstraction for facility services while adhering to coding guidelines.
• Expert knowledge in Inpatient DRG Coding.
• Abstract additional data elements during chart reviews when coding, as needed.
• Adhere to ethical standards of coding per AAPC/AHIMA.
• Maintain performance in coding quality and productivity as directed by Optum.
• Query physicians when appropriate.
• Stay updated with coding knowledge from QM Manager and Directors.
• Participate in coding department meetings and educational events.
• Additional responsibilities as identified by manager.

Skills

Inpatient coding

ICD-10-CM/PCS/DRG

Excel/EMR proficiency

Education

High School Diploma/GED

Job description

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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

Healthcare isn't just changing. It's growing more complex every day. ICD - 10 Coding replaces ICD - 9. Affordable Care adds new challenges and financial constraints. Where does it all lead? Hospitals and Healthcare organizations continue to adapt, and we are vital part of their evolution. And that's what fueled these exciting new opportunities.

Who are we? Optum360. We're a dynamic new partnership formed by Dignity Health and Optum to combine our unique expertise. As part of the growing family of UnitedHealth Group, we'll leverage our compassion, our talent, our resources and experience to bring financial clarity and a full suite of Revenue Management services to Healthcare Providers, nationwide.

If you're looking for a better place to use your passion, your ideas and your desire to drive change, this is the place to be. It's an opportunity to do your life's best work. SM

This position is full-time (40 hours/week) Monday-Friday, normal business hours. It may be necessary, given the business need, to work occasional overtime.

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

Primary Responsibilities

• Identify appropriate assignment of ICD-10 CM, ICD-10-PCS, DRG, and abstraction for facility services while adhering to the official coding guidelines and established client coding guidelines of the assigned facility
• Expert knowledge in Inpatient DRG Coding
• Abstract additional data elements during the chart review process when coding, as needed
• 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 Optum
• 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 directions 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) to be maintained annually
• 3+ years of experience with Inpatient Edits/Denials coding in an acute care facility setting
• 3+ years of experience with ICD-10-CM, ICD-10-PCS, and DRG coding utilizing an encoder
• Intermediate level of proficiency working with PC in a Windows environment, including Microsoft Excel (create and edit spreadsheets) and various EMR systems with ease

Preferred Qualifications

• Ability to work at least one weekend, day, holidays, and overtime when there is a business need

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 where there is 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 - $43 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.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

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