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.

Under direct supervision, the E&M Coder is responsible for accurate coding of the professional services (diagnoses, procedures, and modifiers) from medical records in a hospital/clinic setting.  Analysing the medical record, assigning ICD-CM, CPT, and HCPCS Level II codes with appropriate modifiers.  Medical coding is performed in accordance with the rules, regulations and coding conventions of ICD-10-CM Official Guidelines for Coding and Reporting, CPT guidelines for reporting professional and surgical services, CMS updates, Coding Clinic articles published by the American Hospital Association, assigning codes from HCPCS code book for supplies and equipment, NCCI Edits, and Client Coding Guidelines.

Primary Responsibilities:

• Verifies and abstracts all the relevant data from the medical records to assign appropriate codes for the following settings: Multispecialty Outpatient Clinics, Urgent Care Centres, Inpatient Hospital Setting
• Be able to code 12 charts per hour and meeting the standards for quality criteria
• Needs to constantly track and implement all the updates of AMA guidelines, AHA guidelines, and CMS guidelines
• Be able to review and analyse medical records and add/modify CPT codes for minor surgical procedures, vaccines, and laboratory CPT codes as per documentation
• Be able to extract and code various screening CPT codes and PQRS codes from the documentation
• Be able to check NCCI edits and LCD & NCD coverage determinations and modify ICD-10-CM codes, CPT codes, and modifiers accordingly
• Under general supervision, organizes and prioritizes all work to ensure that records are coded, and edits are resolved in a timeframe that will assure compliance with regulatory and client guidelines
• Adherence with confidentiality and maintains security of systems.  Compliance with HIPAA policies and procedures for confidentiality of all patient records
• 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:

• Life Science or Allied Medicine Graduates with certification from AAPC or AHIMA
• Minimum of 4 to 7 years in multispecialty Evaluation & Management medical coding
• Hands-on experience in coding multispecialty Evaluation & Management services such as Internal Medicine, Family Medicine, Urgent Care, Dermatology, Gastroenterology, Cardiology, Otolaryngology, etc.
• Sound knowledge in Medical Terminology, Human Anatomy & Physiology
• Expertise in determining the EM levels (99202-99215) based on MDM and appending modifiers to CPT codes as per NCCI edits and CPT guidelines
• Demonstrates knowledge of security of systems and associated policies and procedures for maintaining the security of the data contained within the systems
• Proficient in ICD-10-CM, CPT, and HCPCS guidelines
• Proven team player who can work in a large group and provide inputs to the team for betterment of the team in terms of quality and productivity

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.