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Certified Medical Outpatient Edits Coder

4 months ago

Brockton, Massachusetts, United States Optum Full time

$3000 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 and your 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 Medical Outpatient Edits 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. As a Certified Medical Outpatient Edits Coder you will work remotely to accurately determine CPT and ICD-10 Codes for all types of same day surgeries, major Trauma ER encounters, observations, and complex surgery cases including orthopedic and spinal fusions. 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.

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

Work Schedule: Full-time (40 hours/week) Monday- Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours. It may be necessary, given the business need, to work occasional overtime.

Primary Responsibilities:

  • Identify appropriate assignment of CPT and ICD-10 Codes for outpatient surgery, observation, CVIR, emergency, and ancillary services while adhering to the official coding guidelines and established client coding guidelines of the assigned facility
  • Apply coding knowledge to analyze/correct CCI Edits and Medical Necessity accounts
  • 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, as needed, 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, among others
  • 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

What are the reasons to consider working for UnitedHealth Group? Put it all together - competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include:

  • Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays
  • Medical Plan options along with participation in a Health Spending Account or a Health Saving account
  • Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage
  • 401(k) Savings Plan, Employee Stock Purchase Plan
  • Education Reimbursement
  • Employee Discounts
  • Employee Assistance Program
  • Employee Referral Bonus Program
  • Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)
  • More information can be downloaded at:

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 School Diploma/GED (or higher)
  • Professional coder certification with credentialing from AHIMA and/or AAPC (ROCC, CPC, COC, CPC-P, CCS) to be maintained annually
  • 2+ years of Outpatient Facility coding experience
  • Experience with ICD-10
  • Experience with LCD, NCD, Medical Necessity, Modifier Edits
  • Ability to use a PC in a Windows environment, including Microsoft Excel and EMR systems
  • Ability to work flexible hours; Monday- Friday - 40 hours/week, including the flexibility to work occasional overtime per business need

Preferred Qualifications:

  • Experience with complex cardiac catheterizations and interventional radiology (CVIR/IVR)
  • Experience with various encoder systems (eCAC,3M, EPIC)
  • Intermediate level of experience with Microsoft Excel
  • Experience with OSHPD reporting

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, Nevada, Connecticut, New York, New Jersey, Rhode Island or Washington Residents Only: The hourly range for California, Colorado, Nevada, Connecticut, New York, New Jersey, Rhode Island or Washington residents is $18.80 to $36.78 per hour. 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.



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