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.
Primary Responsibilities:
- Auditing coded medical records using the ICD-10 and CPT
- Know and adhere to HIPAA regulations
- Recognize, interpret and evaluate inconsistencies, discrepancies and inaccuracies in the medical data received and appropriately alert and/or query the responsible party, coder and supervisor
- Meet auditor quality and productivity standards and deadlines/turnaround times set up for the process
- Educate coders through feedback on errors
- Analyze, report and conduct sessions on error trend observed
- Conduct/participate/lead calibration calls between SMEs, auditors and trainers
- Report malpractices noticed during auditing of any coder
- Educate coders on coding updates
- Carefully demarcates between educational feedback and errors.
Reviews rebuttals with integrity - Comply with all applicable Company policies, procedures, and business directives, changes including those relating to work location, team assignments, work schedules, and flexible work arrangements
Required Qualifications:
- Graduate or Postgraduate
- Certified coder - AAPC / AHIMA - CCS/CPC/CPC or CIC any one
- 6+ years of hands-on IP DRG Coding
- Solid knowledge of IP-DRG methodology, ICD-10-CM/PCS guidelines, Coding Clinic guidance, and US Healthcare RCM systems
- Thorough knowledge of medical terminology, human anatomy/ physiology, pathophysiology
- Understanding of interpreting the medications and dosages
- Proven good in English communication
- Proven ability to provide proper and detailed feedback on errors and conduct/provide training based on error trends
- Proven ability to participate/conduct/lead calibrations between SMEs, auditors and trainer group
Preferred Qualification:
- Experience with provider query processes, DRG validation, and audit methodologies
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.
Skills Required
- Graduate or postgraduate degree
- AAPC or AHIMA coding certification, such as CCS, CPC, or CIC
- At least 6 years of hands-on IP-DRG coding experience
- Strong knowledge of IP-DRG methodology, ICD-10-CM/PCS guidelines, Coding Clinic guidance, and US healthcare RCM systems
- Thorough knowledge of medical terminology, human anatomy, physiology, and pathophysiology
- Ability to interpret medications and dosages
- Strong English communication skills
- Ability to provide detailed error feedback and conduct training based on error trends
- Ability to participate in, conduct, or lead calibrations among SMEs, auditors, and trainers
- Experience with provider query processes, DRG validation, and audit methodologies
Optum Compensation & Benefits Highlights
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Leave & Time Off Breadth — Paid time off is often regarded as generous, with meaningful accrual and flexibility to use it. While practices can vary by team, the overall time-off offering stands out as a relative strength.
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Retirement Support — A 401(k) plan with employer matching is available and generally well-regarded for supporting long-term savings. It remains valuable, though candidates should verify the current match formula.
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Parental & Family Support — Programs such as parental leave, family medical leave, and adoption assistance are included as notable elements of the total rewards package. These resources can meaningfully support work-life balance when applicable to the role and location.
Optum Insights
What We Do
Optum, part of the UnitedHealth Group family of businesses, 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. At Optum, we support your well-being with an understanding team, extensive benefits and rewarding opportunities. By joining us, you’ll have the resources to drive system transformation while we help you take care of your future. We recognize the power of connection to drive change, improve efficiency and make a difference in health care. Join a team where your skills and ideas can make an impact and where collaboration is key to creating technology that produces healthier outcomes.
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Optum Offices
Hybrid Workspace
Employees engage in a combination of remote and on-site work.
Optum has three workplace models that balance the needs of the business and the responsibilities of each role. These models, core on‑site (5 days/week), hybrid (4 days/week) and telecommute or fully remote, vary by country, role and location.
