UPMC Corporate Revenue Cycle is hiring a Coder II- Profee to join our Coding Department! This position will be a work-from-home position working Monday through Friday during business hours. This role will have the same responsibilities as a Coder I. The position will review all pertinent physician, nursing, and ancillary documentation. Depending on the type of service and place of service, you will determine the level of acuity, procedure(s) performed, billable supplies, and diagnosis to substantiate medical necessity. As well as review and sequence all codes to maximize reimbursement and address any potential bundling issues. The Coder II will apply modifiers as needed. The position will also handle LMRP/CCI edit and coding denial resolution. We are looking for coders with prior experience in ENT coding to join the team. If you are ready to take the next step in your coding career, look no further! Responsibilities: - Utilize computer applications and resources essential to completing the coding process efficiently. - Meet and maintain charge lag and appropriate coding productivity standards within the time frame established by management staff. - Refer problem accounts to appropriate coding or management personnel for resolution. - Identify incomplete documentation in the medical record and formulate a physician query to obtain missing documentation and/or clarification to accurately complete the coding process. - Monitor and resolve coding edits and denials in a timely manner to ensure optimal reimbursement. - Make forward progress within the period toward meeting coding accuracy standards of the departments within the first year of employment. Meet appropriate coding productivity standards within the time frame established by management staff. - Utilize standard coding guidelines, principles and coding clinics to assign the appropriate ICD and CPT codes for all record types to ensure accurate reimbursement. (i.e. use of coding clinics, CPT Assistant, etc) and to determine the level of acuity. Review coding for accuracy and completeness prior to submission to billing system utilizing CCI edits. - Adhere to internal department and system-wide competencies, behaviors, policies and procedures to ensure efficient work processes. Actively participate in monthly coding meetings and share ideas and suggestions for operational improvements. Maintain continuing education by reviewing updated CPT assistant guidelines and updated coding clinics. - Complete work assignments in a timely manner and understand the workflow of the department. Maintain daily productivity statistics and submit a weekly productivity sheet to management. - High school graduate or equivalent. - In lieu of 2 years of coding experience with schooling, a minimum of 3 years experience or CPC certification required. - Graduate of an approved certified coding program preferred with a curriculum that includes Anatomy and Physiology, Pharmacology, Pathophysiology, Medical Terminology, ICD-9-CM and CPT Coding Guidelines and Procedures. - Proficient computer skills with MS excel knowledge preferred. Licensure, Certifications, and Clearances: - Eligible for CPC or CPC specialty certification. - Act 34 UPMC is an Equal Opportunity Employer/Disability/Veteran

Role Description Responsible for accurate and timely intake and interpretation of regulatory and/or functional requirements related to but not limited to coverage, reimbursement, and processing functions to support systems solutions development and maintenance. This role includes coordination with stakeholders and subject matter experts on partnering teams and supporting governance committees where applicable. - Develops and maintains requirement documents related to coverage, reimbursement and other applicable system changes to ensure alignment to regulatory baseline requirements and any health plan developed requirements. - Monitors sources to ensure all updates are aligned. - Leads coordinated development and ongoing management/interpretation review process, committee structure and timing with key partner organizations. - Conducts analysis to identify root causes and assist with problem management as it relates to state requirements. - Communicates requirement interpretations and changes to health plans/product team and various impacted corporate core functional areas for requirement interpretation alignment and approvals as well as solution traceability through regular meetings and other operational process best practices. - Provides support for requirement interpretation inconsistencies and complaints. - Self-organized reporting to ensure health plans/product team and other leadership are aware of work efforts and impact for any prospective or retrospective requirement changes that can impact financials. - Engages with operations leadership and Plan Support functions to review compliance-based issues for benefit planning purposes. Qualifications - At least 4 years of experience in previous roles in a managed care organization, health insurance or directly adjacent field, or equivalent combination of relevant education and experience along with Medical Billing and coding experience. - Policy/government legislative review knowledge. - Strong analytical and problem-solving skills. - Robust knowledge of Office Product Suite including Word, Excel, Outlook and Teams. - Previous success in a dynamic and autonomous work environment. Requirements - Project implementation experience. - Knowledge and experience with federal regulatory policy resources including Centers for Medicare & Medicaid Services (CMS) and the Affordable Care Act (ACA). - Medical Coding certification. Benefits Molina Healthcare offers a competitive benefits and compensation package. Company Description Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

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: - Assigns accurate diagnostic and procedure codes according to clinical documentation and official coding guidelines for outpatient hospital professional accounts - Assigns CPT and ICD-10 codes - Monitors assigned work queues to ensure all records are charged/coded in a timely matter - Generates coding queries for clarification regarding physician documentation as needed - Stays abreast of all changes in coding conventions and coding updates - Ability to manage significant workload, and to work efficiently under pressure meeting established deadlines with minimal supervision - Moderate work experience within own function - Some work is completed without established procedures - Basic tasks are completed without review by others - Supervision/guidance is required for higher level tasks You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear directions 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 CPC coder certification with credentialing from AHIMA and/or AAPC to be maintained annually - 3+ years of experience in a Medical Coder position, specifically in Primary Care or Family Medicine Required Qualifications: - Medicine specialty experience - Profee inpatient experience *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 $20.38 to $36.44 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. #RPO #GREEN

• Reviews medical documentation at a proficient level from clinicians, qualified health professionals and hospitals in order to assign diagnosis and procedure codes utilizing ICD-10 CM/PCS, CPT, and HCPCS • Assigns and ensures correct code selection following Official Coding Guidelines and compliance with federal and insurance regulations in EMR and/or Computer Assisted Coding software • Adheres to the organization and departmental guidelines, policies and protocols • Reviews all clinician documentation to support assigned codes in the health information record so that all significant diagnoses and procedures may be captured for reimbursement and data purposes • Conducts independent research to promote knowledge of coding guidelines, regulatory policies and trends • Practices ethical judgment in assigning and sequencing codes for proper insurance reimbursement • Maintains the confidentiality of patient records • Reports any perceived non-compliant practices to the coding leader or compliance officer • Meets then exceeds departmental quality and productivity standards • Responsible for processing Coding Claim Denials and Coding Claim Rejections, when applicable