Coder, Special Investigations Unit Location: Akron United States Hybrid Job Description: Certified Coder, Special Investigations Unit (SIU) SummaCare - 1200 E Market St, Akron, OH Full-Time / 40 hours / Days - Hybrid or Remote Join a mission‑driven health plan where precision and expertise protect both members and resources-we're seeking a certified coder who can identify discrepancies others miss, analyze coding patterns with accuracy, and turn complex clinical data into clear, actionable insights; if you bring deep knowledge of coding standards, a sharp analytical mindset, and a passion for ensuring integrity in healthcare claims, this is your opportunity to make a meaningful impact and strengthen the quality of care delivery. Summary: Performs review of medical claims to ensure compliance with industry standard coding practices and plan payment policies through a comprehensive medical record evaluation for all provider types. Determines correct coding and appropriate documentation required while ensuring state, federal and company policies are met. Makes recommendations to Medical Directors, Compliance, Internal Audit and the Fraud, Waste and Abuse (FWA) Committee for investigations and provider communication. Maintains knowledge of current schemes and ensures the SIU processes and procedures reflect industry norms. - Formal Education Required: a. Bachelor's Degree, or equivalent combination of education and experience. - Experience & Training Required: a. Three (3) years of health insurance or provider office experience to include: clinical review of medical records, and appropriate claims coding b. Three (3) years' experience of ensuring coding is accurate and compliant with federal regulations, payer policies, and organizational guidelines. c. Active AAPC Coding certification - Certified Professional Coder (CPC). d. Accredited Healthcare Fraud Investigator (AHFI) certification preferred. e. LSS Yellow Belt Certified preferred. Essential Functions: 1) Conducts comprehensive medical record reviews to ensure billing is consistent with the information contained in the medical record. 2) Maintains a working knowledge of coding rules and industry coding guidelines. 3) Provides detailed written summary of medical record review findings. 4) Articulates findings to investigators, plan leadership, law enforcement, legal counsel, providers, state regulators, etc. 5) Reviews and discuss cases with Medical Directors to validate decisions. 6) Assist with investigative research related to coding questions, and state and federal policies. Makes recommendations for additional claim edits. 7) Identifies potential billing errors and provides suggestions for provider education and/or plan payment policies. 8) Identifies opportunities for savings related to potential cases resulting in a prepayment review. 9) Maintains appropriate records, files, documentation, etc. 10) Able to travel for meetings and to testify in legal hearings. - Other Skills, Competencies and Qualifications: a. Demonstrate intermediate proficiency in MS Office, Project, and database management. b. Maintain excellent working knowledge of process improvement techniques, methodologies and principles applying these in the normal course of operations. c. Demonstrate excellent analytical and problem-solving skills. d. Effectively conduct statistical analyses and accurately work with large amounts of data. e. Ability to apply principles of logical thinking to define problems, collect data, establish facts, and draw valid conclusions. f. Ability to organize and manage time to accurately complete tasks within designated time frames in fast paced environment. g. Maintain current knowledge of and comply with regulatory and company policy and procedures. - Level of Physical Demands: a. Sit for prolonged periods of time. b. Bend, stoop, and stretch. c. Lift up to 20 pounds. d. Manual dexterity to operate computer, phone, and standard office machines. Based in Akron, Ohio, SummaCare provides Medicare Advantage, individual and family and commercial insurance plans. SummaCare has one of the highest rated Medicare Advantage plans in the state of Ohio, with a 4.5 out of 5-Star rating for 2026 by the Centers for Medicare and Medicaid Services (CMS). Known for its excellent customer service and personalized attention to members, SummaCare is committed to building lasting relationships. Employees can expect competitive pay and benefits. $28.10/hr - $42.15/hr The salary range on this job posting/advertising is base salary exclusive of any bonuses or differentials. Many factors, such as years of relevant experience and geographical location are considered when determining the starting rate of pay. We believe in the importance of pay equity and consider internal equity of our current team members when determining offers. Please keep in mind that the range that is listed is the full base salary range. Hiring at the maximum of the range would not be typical. Summa Health offers a competitive and comprehensive benefits program to include medical, dental, vision, life, paid time off as well as many other benefits. - Basic Life and Accidental Death & Dismemberment (AD&D) - Supplemental Life and AD&D - Dependent Life Insurance - Short-Term and Long-Term Disability - Accident Insurance, Hospital Indemnity, and Critical Illness - Retirement Savings Plan - Flexible Spending Accounts - Healthcare and Dependent Care - Employee Assistance Program (EAP) - Identity Theft Protection - Pet Insurance - Education Assistance - Daily Pay

Role Description - Learn new systems of clients and effectively transfer knowledge to subordinates. - Lead designated team, ensuring accurate and timely submission of deliverables. - Coach subordinates and develop their skills. - Assist Supervisor/Assistant Manager/Manager in directing the team towards the company's goals. - Ensures compliance with company guidelines and procedures. - Addressing any conflicts within the team that may arise. - Create accurate medical insurance claims and ensure timely submission. - Rectify claim denials with resubmission or appeals. - Formulate and execute strategies to mitigate claim denials. - Learn and implement specialty, state, carrier specific billing requirements. Qualifications - Graduate of any allied medical course (Nursing, PT, MedTech, etc.) preferred but not required. - At least 2–3 years of experience in medical billing, preferably with US healthcare accounts. - With leadership or supervisory experience in a medical billing team is preferred. - Strong knowledge of medical insurance claims processing, claim submissions, denials, and appeals. - Experience in analyzing and resolving claim denials and implementing strategies to reduce them. - Strong coaching, mentoring, and team management skills. - Ability to monitor team performance and ensure timely and accurate submission of deliverables. - Strong organizational, problem-solving, and conflict resolution skills. - Excellent communication and coordination skills. - Able to work from home with reliable internet and a backup connection. Benefits - Work from Home - Equipment/company computer is provided

Title: Medical Coder - Observation Location: Eden Prairie United States 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 together. This position is full-time (40 hours/week) Monday-Friday, normal business hours. It may be necessary, given the business need, to work occasional overtime. You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities: - Expert knowledge in all facility outpatient coding types: Observation - Identify appropriate assignment of ICD-10 Codes, CPT and modifiers for facility services while adhering to the official coding guidelines and established client coding guidelines of the assigned facility - Adhere to the ethical standards of coding as established by AAPC and/or AHIMA - Adhere to and maintain required levels of performance in both coding quality and productivity as established by Optum - Understand the Medicare Ambulatory Payment Classification (APC) codes - Query physicians and forms when appropriate - Knowledge of ICD-10, CPT and HCPCS coding systems, strong medical terminology - Knowledge of NCCI edit policies, Medicare LCD and NCD policies - 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 - Additional responsibilities as identified by manager 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: - High School Diploma/GED - Professional coder certification with credentialing from AHIMA and/or AAPC (CCA, CCS, RHIA, RHIT, CPC-H/COC, CIC, CCS-P, CPC) to be maintained annually - 2+ years of experience with ICD-10, CPT, and modifiers - 2+ years of experience in observation coding - Intermediate level of experience working with a PC in a Windows environment, including Microsoft Excel (create and edit spreadsheets) and various EMR systems with ease - Intermediate level of attention to detail, accuracy and communication Telecommuting Requirements: - Required to have a dedicated work area established that is separated from other living areas and provides information privacy - Ability to keep all company sensitive documents secure (if applicable) - Must live in a location where there is a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service - 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 to $36 per hour based on full-time employment. We comply with all minimum wage laws as applicable. 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. Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. #RPO, #GREEN

Role Description The Risk Adjustment Coder with AHIMA or AAPC certification performs medical record diagnosis code abstraction based upon clinical documentation, ICD-10-CM Official Guidelines for Coding and Reporting, AHA Coding Clinic Guidance, CMS program guidance, and in accordance with all state regulations, federal regulations, internal policies, and internal procedures. The Risk Adjustment Coder will apply guidance provided for the medical record code abstraction primarily for Medicaid lines of business (Complete Code Capture), but may also include Medicare Advantage Risk Adjustment or Commercial Risk Adjustment. - Certified through AHIMA or AAPC required (CRC, CPC, CCS, CCS-P Certification Required). Qualifications - Minimum of 3 years certified with a core coding credential from AHIMA or AAPC. - Must be one of the following: CRC, CPC, CCS, CCS-P. - Experience and proficiency working with Medicaid plans (1+ years). - Strong organizational skills. - Technical savvy with high level of competence in basic computers, Microsoft Outlook, Word, and Excel. - Strong written and verbal communication skills. - Ability to work independently in a remote environment. - Minimum of 1 recent year of production coding experience in Retrospective Risk Adjustment coding (must be within last 6 months). - Required code set knowledge and coding experience in Medicaid (primary), Medicare, and Commercial benefit plans. - Minimum of 1 year coding experience with Complete Code Capture. Requirements - Perform code abstraction of medical records to ensure ICD-10-CM codes are accurately assigned and supported by clinical documentation. - Identify diagnosis and chart level impairments and documentation improvement opportunities for provider education. - Maintain current knowledge of ICD-10-CM codes, CMS documentation requirements, and state and federal regulations. - Ability to pass coding quiz with 80% accuracy. - Consistently maintain a minimum 95% accuracy on coding quality audits. - Meet minimum productivity requirements as outlined by the project terms. - Ability to adhere to client guidelines when superseding other guidelines. - Assist coding leadership by making recommendations for process improvements to further enhance coding goals and outcomes. - Handle other related duties as required or assigned. Benefits - Comprehensive medical, dental, vision, and prescription coverage. - Wellness program supporting overall well-being. - Company-paid basic life and AD&D insurance. - 401(k) plan with company match. - Tuition reimbursement opportunities. - Paid time off for vacation and illness. - Six paid company holidays. - Floating holiday. - Company-paid training and computer equipment. - Performance-based bonus program. - Paid time off for volunteer activities. - Employee referral bonus program. - Career development and training opportunities, including leadership growth.