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.

Primary Responsibilities:

• Accurately responding to research related queries and proposing suggestions for rule changes if applicable
• Develop potential rules that can be applied for clients to adjudicate claims accurately relative to medical policy
• Review State Medicaid guidelines to identify possibility of inappropriate edits for Medicaid claims
• Comply with the terms and conditions of the employment contract, company policies and procedures, and any and all directives (such as, but not limited to, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regards to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment). The Company may adopt, vary or rescind these policies and directives in its absolute discretion and without any limitation (implied or otherwise) on its ability to do so

Required Qualifications:

• Medical degree/ BHMS /BAMS /BPT/Life Science/Other graduation
• Clearance of all major exams (SSC, HSC, qualifying degree) in first attempt
• Clearance of cognitive aptitude test analytical, quantitative, and logical reasoning skills
• Certified medical coder from AAPC/AHIMA
• 2 – 3 years of medical coding experience

Preferred Qualifications:

• Experience in government/private sector/health plan operations with focus on reimbursement and/or claims processing and/or medical coding
• Knowledge of ICD-10 coding
• Knowledge of claim accuracy testing/clinical QA 
• Proven tech savvy with good MS office skills, working knowledge of SQL and exposure to Medicaid 
• Proven solid clinical acumen and analytical abilities
• Proven excellent communication skills

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.