• Utilize available encoder, grouper software, and other coding resources to determine the appropriate ICD-10-CM, CPT, and/or HCPCS including specialty specific codes and Evaluation and Management (E&M) codes. • Maintain an understanding and apply knowledge of National Correct Coding Initiatives (NCCI), Local Coverage Documents and National Coverage Documents (LCD/NCD) directives, Medically Unlikely Edits (MUEs), and Medicare Teaching Physician Guidelines, applying knowledge of applicable regulatory requirements and institutional guidelines to select appropriate codes and modifiers. • Responsible for resolution of pre-bill claim edits (OCE, CCI, MUE, Medical Necessity, etc.) from all Hospital Billing clinical areas. You will strive to produce the cleanest claim possible before it moves on to Billing or out to the payer.

• Reviewing documentation in inpatient and/or IVR (interventional radiology) medical records, and accurately and completely assigning appropriate ICD-10-CM diagnostic and ICD-10-PCS/CPT-4 HCPCS procedural codes to the greatest specificity, assigning the most accurate DRG/APC, when appropriate. • Abstracts demographic and coding information accurately and completely. • Codes and abstracts medical records with a minimum of accuracy. • Accurately and completely assigns appropriate ICD-10-CM diagnostic and ICD-10-PCS/CPT-4 HCPCS procedural codes to the greatest specificity, assigning the most accurate DRG/APC, when appropriate and in accordance with Official Guidelines for Coding and Reporting and Facility Coding Guidelines, as applicable. • Accurately abstracts all required patient demographic data into the EMR. • Accurately assigns correct DRG/APC. • Meets productivity standards. • Queries providers, if needed to further clarify code. • Resolves coding edits and reminders, correcting abstracting and coding issues in a timely manner (1-2 business days). • Completes and routes problem accounts, ready to code, high dollar and other accounts daily to ensure cases are coded as close to goal date as possible. • Completes assigned work by goal date. • Assists with coding unassigned or backlogged accounts. • Serves as a mentor to new coders. • Assists with cleaning up or escalating missing documentation or other work queues. • If proficient, assists with observation, same day surgery, outpatient and emergency coding when needed or assigned.

• Utilize various hospital/physician systems to verify patient, billing and claim information for accuracy • Perform compliant primary/secondary, tertiary and rebill billing functions which can include electronic, paper and portal submission to payers. • Edit claims to meet and satisfy billing compliance guidelines for electronic and hardcopy submission. • Respond timely to emails and telephone messages as appropriate. • Communicate issues to management, including payer, system or escalated account issues. • Participate and attend meetings as requested, training seminars and in-services to develop job knowledge. • Serves and protects the hospital community by adhering to professional standards, hospital policies and procedures, federal, state, and local requirements, and JCAHO standards. • Enhances billing department and hospital reputation by accepting ownership for accomplishing new and different requests; exploring opportunities to add value to job accomplishments. • Update patient demographics/insurance information in appropriate systems • Monitor claims for missing information, authorization, and control numbers (ICN//DCN) • Follows guidelines for prioritization, timely filing deadlines, and notation protocols within appropriate systems. • Secure needed medical documentation required or requested by third party insurance carriers. • Maintain and respect the confidentiality of patient information in accordance with insurance collection guidelines and corporate policy and procedure. • Perform other related duties as required.

Role Description As a member of our team, you will directly improve health outcomes by connecting people with the care, pharmacy benefits, data, and resources they need to feel their best. You will enjoy the flexibility to telecommute from anywhere within the U.S. as you take on some tough challenges. - 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 manner - 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 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 Qualifications - High School Diploma/GED - Professional CPC coder certification with credentialing from AHIMA and/or AAPC to be maintained annually - 5+ years pro-fee coding experience in Orthopedics and podiatry services - Intermediate knowledge of Medicare guidelines and modifier application - Intermediate level of experience in Epic and working with denials Requirements - *All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy. Benefits - Comprehensive benefits package - Incentive and recognition programs - Equity stock purchase - 401k contribution (all benefits are subject to eligibility requirements) - Hourly pay for this role will range from $20 to $36 per hour based on full-time employment