Explore opportunities with Optum,  in strategic partnership with ProHealth Care. ProHealth Care is proud to be a leader in health care services, serving Waukesha County and the surrounding areas for more than a century. Explore opportunities across the full spectrum of care as you help us improve the well-being of the community with your skills, compassion and innovation. Be part of a collaborative environment that strives for excellence, nurtures respect and ensures high-quality care delivery to our patients. Join us in making an impact as an Optum Team Member supporting Pro Health Care and discover the meaning behind Caring. Connecting. Growing together. 

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

Primary Responsibilities

• Assesses and interprets needs of the Ambulatory Coding Team by prioritizing work to meet deadlines
• Identifies solutions to non-standard edits, workflows, and issues
• Solves complex questions and conducts analysis of trends to provide education for the coding staff and clients including physicians/providers
• Provides detailed education to the Coding Team and acts as a resource to others
• Train and review assignments completed by new employees and provide post-hire reviews as needed
• Apply expert coding knowledge to professional coding and billing initiatives and inquiries
• Identify appropriate assignment of ICD-10-CM, CPT, and HCPCS II Codes for physician services, while adhering to the official coding guidelines and established client coding guidelines of the assigned facility
• Identifies aberrant billing patterns and trends, evidence of fraud, waste, or abuse, and recommends providers to be flagged for review
• Understand the Medicare Ambulatory Payment Classification (APC) codes
• 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
• Understand federal coding register and ensure guidelines are used and followed appropriately
• Understanding of appeal process with knowledge how to speak to denial and/or appeals
• Provide documentation feedback to providers and query physicians when appropriate
• Provide education to new onboarding providers as well as continued education to all providers
• Maintain up-to-date Coding knowledge by reviewing materials disseminated/recommended by the Compliance, Coding Operations, etc
• Participate/Lead in coding department meetings and educational events
• Strong knowledge of coding clinics and how to obtain education information
• Process Rebills as appropriate
• Other duties at the discretion of the Coding Supervisor
  • Extensive work experience within own function
  • Work is frequently completed without established procedures
  • Works independently
  • May act as a resource for others
  • May coordinate others' activities
  • Extensive work experience within own function

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 (CPC, CCS-P, RHIA, RHIT) to be maintained annually
• 3+ years of Physician medical coding (ICD-10, CPT, HCPCS II) experience in a multi-specialty physician clinic
• 2+ years of experience with Residency Program (teaching hospital) with coding experience in complex procedures in one or more the following specialty areas: Cardiothoracic, Vascular and Cardiac Catheterizations, Neurology, Neurosurgery, OB/GYN, Hospitalist and other specialties may be applicable
• 2+ years of experience being able to provide expert level coding guidance to physicians, practitioners, and coders as needed
• Intermediate level of knowledge of MUE and NCCI classification and reimbursement structures

• Intermediate level of proficiency in a Windows PC environment, including MS Excel and with Epic and 3M Encoder

Preferred Qualifications:

• Experience auditing charts in a professional coding environment
• Experience providing physician/coding education a plus
• Experience with various systems (Microsoft Teams, Encoder Pro, etc.)
• Experience in Inpatient/Observation E/M coding
• Intermediate level of experience with Microsoft Excel

Soft Skills:

• Must be able to communicate effectively face-to-face and in writing

*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 hourly pay for this role will range from $23.41 to $41.83 per hour 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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