Role 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 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. You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities - Leadership & Staff Management - Supervise day‑to‑day operations of the coding team (inpatient, outpatient, professional, or specialty coders) - Provide coaching, mentoring, and performance evaluations for coding staff - Monitor productivity and quality metrics, ensuring teams meet organizational benchmarks - Develop and maintain staff schedules, manage PTO, and ensure adequate coverage - Lead regular team meetings and training sessions to communicate updates and reinforce expectations - Coding Quality & Compliance - Ensure coding accuracy and adherence to ICD‑10‑CM, CPT, HCPCS, and payer‑specific guidelines - Conduct routine and targeted coding audits; provide feedback and corrective action plans - Stay current with industry regulations (CMS, OIG, NCCI edits, payer bulletins) - Ensure compliance with organizational policies, regulatory requirements, and ethical standards - Workflow & Process Management - Oversee daily work queue (WQ) review, assignment of cases, and timely resolution of holds/deficiencies - Identify barriers and streamline workflows to reduce coding delays and improve revenue cycle performance - Partner with HIM, billing, charge capture, clinical departments, and revenue integrity to resolve coding or documentation issues - Escalate system or operational concerns and help develop corrective action plans - Education & Training - Provide ongoing education to coders regarding guideline changes, documentation requirements, and payer rules - Collaborate with physicians and clinical departments to improve documentation quality and clarity - Develop training materials for new hires and support onboarding processes - Systems, Tools & Reporting - Monitor coding dashboards, WQs, and productivity reports - Participate in EHR or encoder updates, charge capture logic reviews, and testing (e.g., logic changes, edits, workflow redesigns) - Maintain accurate documentation of policies, procedures, and team workflows - Revenue Cycle Support - Partner with billing, editing, and denials teams to investigate and resolve claim holds, rejections, and denials - Analyze trends in denials or payer behavior and implement corrective education or workflow enhancements - Support charge capture accuracy and collaborate on organizational initiatives impacting reimbursement - Collaboration & Communication - Serve as the operational contact for coding-related questions from internal departments - Communicate coding changes, payer updates, and organizational initiatives clearly and timely - Participate in leadership meetings and contribute to strategic planning for the coding/HIM department Qualifications - High School Diploma/GED - Professional CPC coder certification with credentialing from AHIMA and/or AAPC to be maintained annually - 3+ years of medical coding experience in pro-fee coding - 1+ years in supervisory or lead experience (SME experience will be considered for qualification) and the ability to lead, coach, mentor and evaluate coding staff Preferred Qualifications - Associate’s or Bachelor’s degree - Ability to maintain confidentiality and demonstrate professional ethics - Comfortable driving process improvement initiatives and operational changes Soft Skills - Strong interpersonal skills and ability to collaborate with coding, billing, clinical and revenue cycle teams - Excellent written and verbal communication skills for interacting with clinicians and leadership - High attention to detail and commitment to accuracy Benefits - Comprehensive benefits package - Incentive and recognition programs - Equity stock purchase - 401k contribution (all benefits are subject to eligibility requirements) 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.

• Deliver exceptional client service beyond just submitting claims and posting payments. • Research denied claims to ensure every patient visit is paid correctly. • Collaborate with team members to exceed client expectations in collections.

• Contact insurance companies to verify claim status and request reprocessing when needed • Submit and track insurance appeals and corrected claims • Review and analyze aging reports to resolve outstanding claims • Investigate insurance denials and determine appropriate corrective action • Identify denial patterns and report trends to improve billing processes • Prepare, audit, and submit claims to primary and secondary payers • Ensure accurate payment postings and balance allocations • Maintain strict compliance with HIPAA when handling patient financial information

• To ensure accurate and appropriate gathering of information into the coding classification systems to meet departmental, hospital and outside agency requirements. • Responsible for obtaining accurate and complete documentation in the medical record for accurate coding assignment. • Interact with physician and non-physician providers to maximize correct coding initiatives. • Responsible for analyzing and resolving issues of missing charges and problem accounts.