Role Description Under the direction of the DRG Supervisor or designee, the Medical Claims Coding Specialist conducts retrospective medical claims review for coding and pricing determinations, focusing on both outpatient and inpatient services. As a subject matter expert, this role provides coding-related information to various departments and functions as the designated recipient for factual network provider claim review requests. - Serve as the subject matter expert on ICD-10-CM, ICD-10-PCS, CPT, and HCPCS coding of medical claims. - Lead coding projects as directed by Clinical Operations management. - Provide training and mentoring for new and existing Clinical Coders. - Perform DRG Validation of medical claims coding using current coding guidelines and support software. - Conduct focused outpatient and/or inpatient claims reviews and summarize findings. - Identify and report potential fraudulent or quality issues. - Act as a resource for TriWest staff on coding queries. - Research TRICARE manuals to assist with the Referral and Authorization Decision Support tool process. - Monitor timeliness of retrospective claims reviews to ensure compliance with required timelines. - Prepare determination notices and other written correspondence. - Identify questionable review decisions and escalate to the appropriate Medical Director. - Provide accurate data entry in the medical management and claims system. - Review and document coding issues identified by the TRICARE Quality Monitoring Contractor. - Perform other duties as assigned, ensuring regular and reliable attendance. Qualifications - High School Diploma or GED. - Current certification as Certified Inpatient Coder (CIC), Certified Coding Specialist (CCS), or Registered Health Information Technician (RHIT). - U.S. Citizenship required. - Ability to receive a favorable Interim and adjudicated final Department of Defense (DoD) background investigation. - Minimum 5 years of clinical coding experience for facility and/or professional accounts. - Minimum 3 years of claims processing experience for inpatient and/or outpatient accounts. - Documented experience in a fast-paced environment. - Preferred experience in the private medical industry, health insurance, or Managed Care field. - Familiarity with TRICARE and the military healthcare delivery system is preferred. - Advanced knowledge of ICD-10-CM, ICD-10 PCS, HCPCS, and CPT coding; proficiency with Word and Excel. - Strong problem-solving, organizational, and communication skills. - Ability to function in a multi-system Microsoft environment. Benefits - Your Health, Your Way: Choose from two comprehensive medical plans through Blue Cross Blue Shield, with dental and vision coverage included. - Peace of Mind: Protect what matters most with life, critical illness, and accident insurance through Unum. - Flexibility for Life: Plan ahead and save with a Flexible Spending Account and Daycare FSA through Navia. - Extra Protection When You Need It: Our Health Gap Insurance through Sun Life helps cover unexpected costs. - Your Future Starts Now: Build your future with our 401(k) plan through The Standard, eligible after just six months.

Role Description Using established policies and procedures, the Certified Coder translates narrative descriptions of diseases, injuries, and medical procedures into numeric or alphanumeric codes needed for billing. The Certified Coder may code all types of: - Inpatient cases - Observation cases - Outpatient cases (including clinics, ancillary services, and ambulatory surgery) - Emergency room cases The Certified Coder may also be called upon to code highly complex inpatient records based on experience and skill set, including: - Trauma cases - Burn cases - Open heart cases - Transplant cases Qualifications - Certification as a Coder - Experience in coding inpatient and outpatient cases - Knowledge of medical terminology and coding systems Requirements - Ability to work with established policies and procedures - Strong attention to detail - Ability to handle complex coding assignments Benefits - Opportunities for skill development - Career growth potential - Inclusive and equitable workplace

Role Description This position is located in the Health Information Management (HIM) section at the El Paso VA Health Care System. MRTs (Coder) are skilled in classifying medical data from patient health records in the hospital setting, and/or physician-based settings, such as physician offices, group practices, multi-specialty clinics, and specialty centers. - Assigns codes to documented patient care encounters (inpatient and/or outpatient) covering the full range of health care services provided by the VAMC. - Monitors ever-changing regulatory and policy requirements affecting coded information for the full spectrum of services provided by the VAMC. - Assists facility staff with documentation requirements to completely and accurately reflect the patient care provided. - Utilizes the facility computer system and software applications to correctly code, abstract, record, and transmit data to the national VA database in Austin. - Monitors the status and progress of work and day-to-day adjustments in accordance with established priorities. - Trains and works closely with professional and administrative staff to assist in the development, maintenance and usage of ICD and CPT codes. - Identifies training needs of individuals based on productivity and accuracy reports, rejects from billing, and spot checks. - Takes the initiative in one-on-one provider training to improve health record documentation for the episodes of care provided. - Educates providers through feedback, email queries, or informal meetings. Qualifications - Five years minimum experience analyzing the health record to identify all pertinent diagnoses and procedures for coding. - Five years minimum experience reading and understanding the content of the health record, terminology, and disease process/pathophysiology. - Five years minimum experience working throughout various outpatient coding genres. - Ability to work with a team to provide technical guidance, plan, organize, and coordinate activities. - Advanced knowledge of current coding classification systems for the subspecialty being assigned. - Ability to foster collaboration, guide staff growth, and maintain a positive, productive work environment. Requirements - United States Citizenship. - One year of creditable experience that indicates knowledge of medical terminology, anatomy, physiology, pathophysiology, medical coding, and the structure and format of health records. - Associate's degree from an accredited college or university recognized by the U.S. Department of Education in health information technology/health information management, or a related degree. - Completion of an AHIMA approved coding program or other intense coding training program. - Certification through AHIMA or AAPC. - Proficiency in spoken and written English. Benefits - Not Authorized for Relocation/Recruitment Incentives. - Permanent Change of Station (PCS): Not Authorized. Company Description For more information on this qualification standard, please visit VA Qualification Standards .

Title: Medical Coder - Primary Care or Family Medicine Location: Albany United States Requisition number: 2339753 Job category: Medical & Clinical Operations Primary location: Albany, NY Overtime status: Non-exempt Travel: No 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 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.