Senior (IP) Acute Edits Certified Medical Coder

iCode Academy; Eden Prairie (MN); Hybrid; USD 85,000 - 110,000; Full time

Benefits offered by this job

Sign-on bonus $3,000 for external-apps

Job summary

Optum360 is hiring a Senior (IP) Acute Edits Certified Medical Coder to work remotely within the U.S., with the primary location noted as Eden Prairie, MN. You will ensure accurate ICD-10-CM/ICD-10-PCS and CPT coding, manage DRG impact, and provide constructive feedback to physicians under QM leadership.

This full-time role requires inpatient coding expertise, AHIMA/AAPC credentials, and strong knowledge of OCE/MUE/NCCI, with a sign-on bonus of $3,000 for external applicants.

Qualifications

• 3+ years inpatient medical coding experience in hospital/facility.
• AHIMA and/or AAPC professional coder certification (CCS, RHIA, RHIT, CIC, ROCC, CPC, COC, CPC-P).
• High School Diploma or GED.
• Experience with OCE, MUE and NCCI classifications and reimbursement structures.
• Experience in level I trauma center and teaching hospital environments with complex cases.
• ICD-10 and DRG coding experience; proficient in Windows and MS Excel.

Responsibilities

• Identify appropriate ICD-10-CM/ICD-10-PCS codes for inpatient services and DRG impact.
• Identify CPT and ICD-10 codes for outpatient surgery and ancillary services.
• Understand Medicare APC codes and applicable guidelines.
• Abstract data elements during chart review when coding is needed.
• Provide documentation feedback to providers and query physicians as needed.
• Maintain up-to-date coding knowledge and participate in departmental meetings.

Skills

Inpatient medical coding

ICD-10 coding

CPT coding

Education

High School Diploma

AHIMA/AAPC certification

Tools

OSHPD reporting

3M encoder

EPIC

Excel

EMR systems

Job description

Senior (IP) Acute Edits Certified Medical Coder

Job Category: Medical & Clinical Operations

Primary Location: Eden Prairie, MN
(Remote considered)

$3,000 SIGN ON BONUS FOR EXTERNAL APPLICANTS

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.Come make an impact on the communities we serve as we help advance health equity on a global scale. Here, you will find talented peers, comprehensive benefits, a culture guided by diversity and inclusion, career growth opportunities andyour life’s best work.SM

Delivering quality care starts with ensuring our processes and documentation standards are being met and kept at the highest level possible. This means working behind the scenes ensuring a member-centric approach to care. As a Certified Sr. (IP) Acute Edits Medical Coder you will determine and record the correct medical codes for all treatments and health services. Ensuring proper records is just one way your work will impact the health and wellness of our members on a huge scale.

Who are we? We’re Optum360. We're a dynamic new partnership formed by Dignity Health and Optum to combine our unique expertise. As part of the growing family ofUnitedHealth 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 health care providers nationwide.

As a Certified Sr. (IP) Acute Edits Medical Coderyou will work remotely tocorrect CCI, MUE, and Medical Necessity Edits on accounts of all patient types in addition to periodic coding. 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.

Schedule: This position is full-time, Monday – Friday. Employees are required to work our normal business hours of 8:00am – 5:00pm. It may be necessary, given the business need, to work occasional overtime or weekends.

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 and ICD-10-PCS Codes for inpatient services provided in a hospital setting and understand their impact on the DRG with reference to CC/MCC, while adhering to the official coding guidelines and established client coding guidelines of the assigned facility

Identify appropriate assignment of CPT and ICD-10 Codes for outpatient surgery, observation, emergency, and ancillary services while adhering to the official coding guidelines and established client coding guidelines of the assigned facility

Understand the Medicare Ambulatory Payment Classification (APC) codes

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 Optum360

Provide documentation feedback to providers 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, etc.

Participate in coding department meetings and educational events

Review and maintain a record of charts coded, held, and/or missing

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 SchoolDiploma /GED (or higher)

Professional coder certification with credentialing from AHIMA and/or AAPC (CCS, RHIA, RHIT, CIC, ROCC, CPC, COC, CPC-P) to be maintained annually

3+ years of recent inpatient medical coding experience (hospital, facility, etc.)

2+ years of recent working experience with OCE, MUE and NCCI classification and reimbursement structures

Experience working in a level I trauma center and/or teaching hospital with a mastery of complex procedures, major trauma ER encounters, cardiac catheterization, interventional radiology, orthopedic and neurology cases, and observation coding

ICD-10 and DRG coding experience

Ability to use a PC in a Windows environment, including MS Excel and EMR systems

Preferred Qualifications:

Experience with OSHPD reporting

Experience with various encoder systems (eCAC,3M, EPIC)

Intermediate level of proficiency with Microsoft Excel

Careers with Optum.Our objective is to make health care simpler and more effective for everyone. With our hands at work across all aspects of health, you can play a role in creating a healthier world, one insight, one connection and one person at a time. We bring together some of the greatest minds and ideas to take health care to its fullest potential, promoting health equity and accessibility. Work with diverse, engaged and high-performing teams to help solve important challenges.

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

**PLEASE NOTE** The sign-on bonus is only available to external candidates. Candidates who are currently working for UnitedHealth Group, UnitedHealthcare or a related entity in a full time, part time or per diem basis (“Internal Candidates”) are not eligible to receive a sign on bonus.

California, Colorado, Connecticut, Nevada, New York, Washington or Rhode Island Residents Only:The hourly range for California, Colorado, Connecticut, Nevada, Washington or New York City residents is $22.45 to $43.89.Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.