• Reviews medical records to identify pertinent diagnoses and procedures. • Selects the principal diagnosis and principal procedure. • Ensures appropriate DRG assignment. • Abstracts appropriate information from the medical record. • Responsible for utilizing company applications to enter charts coded in real-time. • Solicits clarification from the physician regarding ambiguous or conflicting documentation. • Participate in team meetings and training required by the company or client. • Maintains current knowledge of the information contained in the Coding Clinic, CPT Assistant, and the Official Guidelines for Coding and Reporting.

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. Schedule: Monday - Friday except for weekends for a shift differential. You will enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities: - Identify appropriate assignment of ICD - 10 - CM and ICD - 10 - PCS Codes for inpatient services provided in a hospital setting and understand their impact on the DRG with reference to CC / MCC, while adhering to the official coding guidelines and established client coding guidelines of the assigned facility. - Abstract additional data elements during the Chart Review process when coding, as needed. - 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 Optum360. - Provide documentation feedback to providers and query physicians when appropriate. - Maintain up-to-date Coding knowledge by reviewing materials disseminated / recommended by the QM Manager, Coding Operations Managers, and Director of Coding / Quality Management, etc. - Participate in coding department meetings and educational events. - Review and maintain a record of charts coded, held, and / or missing. Qualifications - High School Diploma/GED - Professional coder certification with credentialing from AHIMA and/or AAPC (RHIT, RHIA, CCS, OR CIC) to be maintained annually. - 3+ years of experience in Acute Care Inpatient medical coding (hospital, facility, etc.). - 3+ years of experience working with DRG coding with a mastery of complex procedures, cardiac catheterization, complex cardiology, interventional radiology, orthopedic and neurology cases. - 3+ years of training and experience using ICD-10-PCS procedure coding. Requirements - *All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy. Benefits - Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays. - Medical Plan options along with participation in a Health Spending Account or a Health Saving account. - Dental, Vision, Life & AD&D Insurance along with Short-term disability and Long-Term Disability coverage. - 401(k) Savings Plan, Employee Stock Purchase Plan. - Education Reimbursement. - Employee Discounts. - Employee Assistance Program. - Employee Referral Bonus Program. - Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.).

Role Description As an Outpatient Coding Specialist, you will: - Assign diagnosis and procedure codes using the appropriate coding classification system on all episodes of care in various settings. - Ensure compliance with official guidelines (ICD-10-CM, AHA Coding Clinic, AMA CPT Assistant and Guidelines) and LifePoint Health Support Center (HSC) policies. - Utilize ICD 10-CM, CPT, and HCPCS according to CMS requirements for hospital billing. - Achieve and maintain 95% accuracy on quality reviews and assigned productivity standards. - Be familiar with Ambulatory Payment Categories (APCs), OPPS, NCCI guidelines, and medical necessity/compliance guidelines. - Verify, edit and/or enter charges based on documentation or payer/billing. - Maintain knowledge of applicable rules, regulations, policies, laws, and guidelines that impact the coding area. - Follow coding workflows for service type and address compliance reviews. - Submit physician queries when clarification of documentation is needed. - Facilitate a positive working relationship with physicians, nurses, medical staff, and hospital employees. - Assist in training and reviewing the work of other coders for accuracy and efficiency. - Make recommendations to the supervisor and monitor results as appropriate. - Seek advice and guidance as needed to ensure proper understanding. - Assist others with responsibilities and adjust work schedule to meet department needs. - Use independent discretion/decision-making while effectively working remotely. - Attend required educational webinars, conference calls, and coding seminars. - Maintain coding education hours and renew annual coding credentials as applicable. - Complete all assigned compliance courses within the designated period. - Conform to AHIMA’s Code of Ethics and Standards of Ethical Coding. - Ensure patient/employee privacy and dignity by maintaining confidentiality. - Perform other related job tasks or responsibilities as assigned. Qualifications - Associate degree in health-related field preferred. - One year of outpatient coding experience in an acute care hospital is preferred. - Certifications: CCA, CPC, CCS, or RHIT preferred. Requirements - Must be authorized to work in the United States without employer sponsorship. Benefits - Comprehensive Benefits: Multiple levels of medical, dental, and vision coverage for full-time and part-time employees. - Financial Protection & PTO: Life, accident, critical illness, hospital indemnity insurance, short- and long-term disability, paid family leave, and paid time off. - Financial & Career Growth: Higher education and certification tuition assistance, loan assistance, and 401(k) retirement package with company match. - Employee Well-being: Mental, physical, and financial wellness programs (free gym memberships, virtual care appointments, mental health services, and discount programs). - Professional Development: Ongoing learning and career advancement opportunities.

• Perform coding and related duties using established billing office policies in an accurate and timely manner. • Primary contact with physicians, department administrators, hospital and/or clinical department administrators and their support staff and billing staff. • Coordinates professional service billings for selected clinical departments. • Assignment or verification of CPT, ICD-10 CM coding and modifiers based upon documentation. • Resolve edits for electronic charges, following established policies and procedures to ensure that all data elements are applied. • Monitor charge flow and act as a liaison with managers, department administrators and other billing personnel to assure consistent and accurate change flow. • Identify, report, and resolve coding and reimbursement issues.