Special Investigations Unit Pre Pay Coding Consultant

UnitedHealth Group; Plymouth (MA); On-site; USD 33,000 - 59,000; Full time

Job summary

UnitedHealth Group's Optum is seeking a certified medical coder for a remote, full-time role across the U.S. This position offers virtual training and requires CPT coding proficiency and auditing experience.

You will apply coding guidelines, interpret clinical documentation, and ensure accurate code assignments while contributing to revenue integrity. Standard business hours apply, with potential overtime.

Qualifications

• High School Diploma or GED required.
• Certified Coder with CPC or AHIMA (CCS/RHIT/RHIA).
• 3+ years CPT coding experience.
• Recent coding/auditing experience (last 1–2 years).
• Proficient with PC-based software.
• Ability to work standard hours 8:00–17:00 local time, Mon–Fri; overtime/weekends may be required.
• Must be 18+ years old.

Responsibilities

• Identify appropriate medical codes from documentation and guidelines.
• Interpret clinical documentation to assign accurate codes.
• Use medical coding software and references to select codes.
• Record independent medical code determinations and support audits.
• Educate and mentor others to improve coding quality.
• Maintain productivity and turnaround time standards.

Skills

CPT coding

Medical coding

Analytical skills

Teamwork

Education

High School Diploma/GED

CPC/AHIMA certification

Tools

PC-based software

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.

This position is full-time, Monday - Friday. Employees are required to work our normal business. It may be necessary, given business need, to work occasionally overtime or weekends.

We offer weeks of paid on-the-job training. The hours during training will be 8:00am to 5:00pm CST, Monday - Friday.Training will be conducted virtually from your home.

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

Primary Responsibilities:

• Utilize resources and reference materials (e.g., on-line sources, manuals) to identify appropriate medical codes and reference code applicability, rules and guidelines
• Apply understanding of relevant medical coding subject areas (e.g., diagnosis, procedural, evaluation and management, ancillary services) to assign appropriate medical codes
• Apply understanding of basic anatomy and physiology to interpret clinical documentation and identify applicable medical codes
• Utilize medical coding software programs or reference materials to identify appropriate codes
• Apply relevant Medical Coding Reference, Federal, State, and Professional guidelines to assign and record independent medical code determinations
• Manage multiple work demands simultaneously to maintain relevant productivity and turnaround time standards for completing medical records (e.g., charts, assessments, visits, encounters)
• Provide information or respond to questions from medical coding quality audits
• Educate and mentor others to improve medical coding quality
• Demonstrate basic knowledge of the impact of coding decisions on revenue cycle
• Attain and/or maintain relevant professional certifications and continuing education seminars as required
• All other duties as assigned

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
• Certified Coderwith credentials from AAPC with a CPC or AHIMA with CCS, RHIT, RHIA
• 3+ years of CPT coding experience
• Recent professional coding/auditing experience within the last 1-2 years
• Intermediate level of proficiency with PC based software
• Ability to work our normal business hours of 8:00am - 5:00pm, Monday - Friday. It may be necessary, given the business need, to work occasionally overtime or weekends
• Must be 18 years of age or older

Preferred Qualifications:

• AHFI or CFE certification
• Licensed Registered Nurse (RN)
• Licensed Practical Nurse (LPN)
• Experience in a production environment
• Experience with one or more of the following:
  • Claim processing
  • Provider demographic information
  • Insurance billing practices

Soft Skills:

• Ability to prioritize and manage multiple tasks
• Proven ability to work in a team setting
• Excellent oral and written communication skills and presentation skills
• Critical thinking, problem solving and analytical skills

*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 salary for this role willrangefrom $24 to $43 annually 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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