Senior Medical Coding Analyst

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 Coder Functions Verifying the coding of the diagnosis evaluation and management procedures modifiers or other codes required for the completeness and accuracy of the record Review examine and verify component parts of medical records Ensure completeness and accuracy of billed service Consistency and completeness of coding using established CMS criteria and regulations Authorized signatures and patient identification to ensure all documents contain sufficient documentation to support the diagnosis and treatment administered and the results obtained are adequately described Review diagnosis therapeutic and diagnostic procedures supplies materials injections and drugs with International Classification of Diseases ICD10 Current Procedural Terminology CPT Heath Care Financing Administration Common Procedure Coding Systems HCPCS - all levels and any other coding classification systems that may be required Primary Responsibilities Validate the claim denial reason and logic in our internal claim processing platforms and confirm that the logic is correctly applied according to CMS coding policies including but not limited to NCCI Policy NCD LCD Medicare Claim Processing Manual From a Part C perspective we cannot use UHC payment policies unless there is a direct CMS source of truth to support Search for information in cases where the coding is complex or unusual Interpret appeal validate claim processing and tie that denial of service directly to a CMS policy that is both applicable to the date of service and provider specialty to determine if the denial should be overturned or upheld Ensure all the provider s arguments are reviewed and resolved with a concise timeline narrative explanation including the direct sourcing to support the denial uphold if applicable Comply with the terms and conditions of the employment contract company policies and procedures and any and all directives such as but not limited to transfer and or re-assignment to different work locations change in teams and or work shifts policies in regard to flexibility of work benefits and or work environment alternative work arrangements and other decisions that may arise due to the changing business environment The Company may adopt vary or rescind these policies and directives in its absolute discretion and without any limitation implied or otherwise on its ability to do so Ability to navigate understand functionality COSMOS Facets Claim forms ATS CMS gov Outpatient Code Editor CES SAM edit Eligibility To apply to an internal job employees must meet the following criteria Candidates at SG24 and SG25 can apply SG24 will move to SG25 and SG25 will move laterally ME 3 and above in last Common review cycle Not on Active CAP or Active disciplinary action Time in Role Guidelines Should have been in your current position for a minimum of 12 months if you have not met the recommended minimum time in role discuss your career interest with your manager and gain alignment prior to applying And share the alignment email with respective recruiter while applying Required Qualifications Bachelor s Degree or 5 years of technical writing experience 5 years Coding and auditing experience E M CPT HCPCS Preferable Denial Coding Exposure in client interactions Experience with spreadsheet and word processing management such as Excel and Word Demonstrated ability to manage and prioritize deliverables Proven excellent verbal and written communication skills Proven organizational skills with ability to be flexible and work with ambiguity Work with minimal guidance seek guidance on only the most complex tasks Proven attention to detail Preferred Qualifications Coding Certification examples CPC CCS CCS-P RHIT RHIA etc or willing to obtain upon hire Experience with standard healthcare industry code sets such as E M CPT HCPCS ICD10 etc Knowledge on Denials and Medicare Medicaid policies and CMS Guidelines 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