Senior Inpatient Medical Coder - Acute Edits & Denials

ISHE; Eden Prairie (MN); Hybrid; USD 33,000 - 59,000; Full time

Job summary

UnitedHealth Group is seeking a Senior Inpatient Medical Coder/Acute Edits and Denials Claims Analyst to correct CCIs, MUE edits, and medical necessity edits, while handling three-day rule combinations and other queues. This remote role supports Allina Health in ensuring accurate inpatient coding.

You will query physicians for documentation and assign MS-DRG/APR-DRG, with a focus on compliance and data integrity, leveraging strong coding knowledge.

Qualifications

• Associate's degree required.
• Coding credentials required on hire (RHIA/RHIT/CCS/CIC, AHIMA or AHIMA/AAPC).
• 2+ years of inpatient hospital coding experience.

Responsibilities

• Work acute inpatient hospital claim edits, denials, 3-day rule combines and other secondary queues for Allina Health.
• Recodes medical records to satisfy claims, edits, and denials using coding classifications to ensure data integrity.
• Analyzes medical records to ensure accurate coding and provide provider feedback to improve documentation.
• Collects and abstracts data elements.
• Assists customers with unbilled and incomplete records.
• Identifies and suggests improvements in high compliance risk coding areas.
• Combine accounts and collaborate on charging and documentation requirements; participate in payer and compliance reviews.
• Other duties as assigned.

Skills

2+ years coding experience

2+ years acute inpatient coding

Education

Associate's degree

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 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.

As a Senior Inpatient Medical Coder/Acute Edits and Denials Claims Analyst, you will work remotely to correct, CCI, Medically Unlikely (MUE) Edits, and Medical Necessity Edits in addition to periodic coding.

You will also work combine 3 day payment window, denial claim edit, dental and various other WQ accounts.

You will ensure that all Inpatient acute hospital 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 querying physicians for documentation under the direction of the Coding Operations Manager or Quality Management personnel.

Experience with the following acute inpatient hospital coding elements is required: MS- DRG and APR DRG (severity and risk of mortality) assignment, complication and comorbidity secondary diagnosis code identification, present on admission indicators, ICD-10-PCS procedure code assignment.

Experience with charge, supply codes, EPIC Account Activities functions and payer billing workflows is beneficial but not required (these will be trained).

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

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

Responsibilities

• Work acute inpatient hospital claim edits, denials, 3-day rule combines and other secondary work queues for Allina Health.
• (Coding) Recodes medical records to satisfy the claims, edits, and denials using coding classifications to ensure data integrity and proper assignments.
• (Coding) Analyzes medical records to ensure accurate coding, and send provider feedback to improve the quality of documentation to support code assignment and billing.
• (Coding) Collects and abstracts data elements.
• Assists customers to address complex issues related to unbilled and incomplete records.
• Identifies and suggests areas of improvement in high compliance risk coding areas.
• Combine accounts; identifies codes that require charge build, collaborate with other departments on charging and documentation requirements, participates in special projects involving payer and compliance reviews
• Other duties as assigned.

Required Qualifications

• Associate's degree
• One of the following credentials is required upon hire required, and to be maintained annually:
  • Coder certification with credentialing from AHIMA and/or AAPC (RHIA, RHIT, CCS, CIC)
  • Certified Coding Specialist - American Health Information Management Association (AHIMA)
  • CIC Certified Inpatient Coder from American Academy of Professional Coders (AAPC)
  • Registered Health Information Technician - American Health Information Management Association (AHIMA)
  • Registered Health Information Admin - American Health Information Management Association (AHIMA)
• 2+ years of Coding experience
• 2+ years of Acute Care inpatient medical coding experience (hospital, facility, etc.)

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.

#RPO, #GREEN