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Coding Consultant, IFP Product

4 months ago

Minnetonka, United States UnitedHealth Group Full time

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together.

Individual and Family Plans (IFP) is a growing business within UnitedHealthcare. The Coding Consultant for IFP Product provides medical coding expertise to support internal policy development, benefit definition and accurate benefit configuration. They research and interpret healthcare correct coding using regulatory requirements and guidance related to CMS and CPT/AMA, review other major payer policies, and use internal business rules and policies to prepare written documentation in support of benefit configuration. The Coding Consultant for IFP Product possesses an overall understanding of all coding principles, including facility and physician coding and dental coding.

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


Primary Responsibilities:

  • Serve as a coding resource and provide coding expertise and guidance for IFP Product and configuration partners
  • Develop and maintain code sets used to define IFP medical and specialty benefits (hearing, vision, dental), seeking and promoting enterprise alignment when appropriate
  • In partnership with Product and Clinical partners, ensure IFP sources of truth for benefit administration/configuration (e.g., benefit configuration guidelines, Pay Code Status lists, etc.) contain accurate and complete CPT, HCPCS, Revenue, CDT and/or ICD-10 codes to support benefit intent
  • Monitor annual and quarterly code updates, identify impacts to IFP Product documentation, and update documentation as needed
  • Ensure adherence to state and federal policies/mandates, reimbursement policies and contract requirements
  • Facilitate meetings with key partners, including: Clinical, Operations, Claims, Configuration and others to achieve benefit design coding solutions
  • Research and interpret correct coding guidelines and internal business rules to respond to benefit inquiries and issues
  • Identify and recommend opportunities for cost savings and improving outcomes


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.

One year of post-high school education can be substituted/is equivalent to one year of experience.

Required Qualifications:

  • Possess and maintain one or more of the following coding credentials: CPC, CCS-P, CCS, CPMA or equivalent
  • 3+ years of medical coding experience in a health insurance product implementation, benefit/coverage policy development, benefit configuration, or claims role
  • Experience analyzing data and/or regulatory requirements, problem solving, and providing fact-based recommendations or make decisions based on analysis
  • Experience performing clinical coverage review of post-service (pre-or-post payment) of claims requiring interpretation of state and federal mandates; certificates of coverage, medical and reimbursement policies, coding requirements and consideration of relevant clinical information on claims
  • Experience multi-tasking, prioritizing, and managing time efficiently across multiple work partners
  • Proven knowledge of commercial medical insurance benefits


Preferred Qualifications:

  • Experience with health insurance reimbursement policy
  • Proven familiarity of SNOMED, LOINC, NDC and CDT
  • Experience in the plan build/plan configuration
  • Demonstrated ability to work collaboratively and influence others to drive timely decisions
  • Ability to work independently, or as an active member of a team
  • Proficient in Microsoft Word, Excel, PowerPoint, etc.
  • Accurate and precise attention to detail
  • Excellent analytical, verbal and written communication skills


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

California, Colorado, Connecticut, Nevada, New Jersey, New York, Rhode Island, or Washington Residents Only: The salary range for California, Colorado, Connecticut, Nevada, New Jersey, New York, Rhode Island or Washington residents is $85,000 to $167,300 per year. 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.


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.