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 diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing togetherThis process works on identifying discrepancies between medical records and billed services for complex and high value claims by identifying Up-coding, Unbundling, Duplication, and Misrepresentation of services. They approve/deny claims & Identify provider aberrant behavior patterns. The associates prevent the payment of potentially fraudulent and/or abusive claims utilizing medical expertise, knowledge of CPT/ diagnosis codes, CMC guideline along with referring to client specific guidelines and member policiesPrimary Responsibilities:

• Adheres to and maintains required levels of performance in both accuracy and productivity
• Understands coding guidelines and associated UHC policies
• Provide documentation feedback as needed
• 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
• Understands, articulates, and implements best practices related to his area of expertise
• Oversees the development, testing and implementation of technical solutions and validates that the final product satisfies the defined requirements
• Reviews technical documentation, such as user guides, training manuals and system specifications, prior to distribution to end-users and ensures his subject area is accurately represented
• Supplies source materials, reference items, and supplemental resources
• Contributes core content and original materials and suggests exercises and/or case studies to reinforce learning
• Articulates and communicates information effectively to diverse audiences
• Assists with other ad hoc responsibilities deemed necessary by his/her supervisors
• 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 regards 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

Required Qualifications:

• Graduate and Board-passer (one-time take) of any Allied Medical Profession (Nurse, Physical/Occupational/Speech Therapist, Medical Technologist, etc.) with 1+ years of clinical/hospital experience
• AAPC or AHIMA Certified or any equivalent coding certification
• Meets expectations in the last common review for internal applicants
• 1+ years of Medical Coding experience
• 1+ years of experience as Supervisor - Team handling experience

Preferred Qualification:

• Claims processing experience in a BPO/HMO setting

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