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.
Reporting to the Provider Education and Escalations Manager, the Coding Education Consultant is part of a team responsible for conducting coding audits for escalated claims and providing coding education to providers and facilities who are inaccurately billing.
This role will primarily focus on the presentation of medical coding content on common billing errors, performing audits on escalated claims, and providing feedback on completed claim audits. This position requires the coder to present/deliver coding education in a variety of settings both internally and externally: (not limited to) educational boot camps, expo event class, provider/facility offices, method of delivery is mainly via telephonic or virtual (i.e.: Webex) meetings.
You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:
Create and deliver presentation materials to facilitate provider education
Lead provider education meetings to drive issue resolution, including potential onsite provider meetings
Apply principles of adult learning and training best practices to deliver effective and innovative training material
Create supporting materials for learning activities (e.g., agendas, schedules, letters, audio/visual aids, etc.)
Leverage/modify existing training solutions to meet current needs
Act as a subject matter expert for internal and external partners in the form of assistance with medical coding, documentation requirements based off industry standards
Ensures adherence to state and federal mandates for all coding guidance, applicable benefit language, medical & reimbursement policies, coding requirements and consideration of relevant clinical information
Possesses strong decision-making skills on complex claim audits
Analyze and interpret claims data and medical records/documentation to understand the historical activity and determine validity of the payment/denial on a claim
Identifies aberrant billing patterns and trends, evidence of fraud, waste, or abuse, and recommends providers to be flagged for review
Maintains and manages daily assignments, with accountability to quality, utilization, and productivity standards
Discussing the findings as a collaborative team with UHN advocacy, UHC PPS and analyst before approaching the provider call
Maintaining positive provider and network relationships
Actively owning and resolving issues for Best in Class and / or high-profile providers encountered during education session
Analyze data trends prior to education outreach to ensure provider billing errors are addressed in a holistic fashion
Responsible for managing individual workload with a high emphasis on quality
Assume additional responsibilities as assigned
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:
5+ years of experience as a Certified Coder – active coding certification (CPC, CIC, CCS, RHIT, RHIA etc.
5+ years of experience working in the health insurance business, including knowledge of industry terminology, and regulatory guidelines
3+ years in Optum FWAE clinical operations as a clinical investigator or similar role (i.e. appeals/reconsideration reviewer, Team Lead)
3+ years providing formal training on medical coding
2+ years of customer service experience
Fully proficient with MS products such as Word, PowerPoint, and Excel
Proven solid written, verbal, analytical, organizational, time management and problem-solving skills
Proven ability to work independently
Proven excellent time management, organizational and prioritization skills to balance multiple priorities
Proven effective interpersonal, influence, collaboration and listening skills for success individually and in a team setting
Demonstrated ability to adapt in a dynamic and high-growth environment
Preferred Qualifications:
Bachelor’s degree
Training Certification
CDI Certification
Managed care experience
Fraud Investigational and/or Auditing experience
Knowledge of claims platforms
*All employees working remotely 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 salary for this role will range from $71,200 to $127,200 annually based on full-time employment. We comply with all minimum wage laws as applicable.
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.
UnitedHealth Group
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