Employer: UnitedHealth Group
job description:
You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
Combine two of the fastest – growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that’s improving the lives of millions. Here, innovation isn’t about another gadget, it’s about making Healthcare data available wherever and whenever people need it, safely and reliably. There’s no room for error. Join us and start doing your life’s best work.SM
Under direction of the Coding Manager, the primary responsibility of the Medical Coder is to ensure that codes representing current International Classification of Diseases, 9th Revision (ICD-9) or 10th Revision (ICD-10), Current Procedural Terminology (CPT), and the Healthcare Common Procedure Coding System (HCPCS) accurately reflect documented services by applying a demonstrated knowledge of anatomy, physiology and medical terminology as well as compliant coding rules and regulations, including medical necessity and modifiers. Additionally, the Medical Coder serves as the key resource to the Chief and Administrative Director and/or Manager regarding coding changes affecting assigned clinical areas, ongoing coding reviews of providers, and trends associated with coding utilization and optimization, denial management, reimbursement, and customer services issues. The Medical Coder is ultimately responsible for efficient charge capture and reconciliation processes (electronic or paper), knowing and meeting expected targets at sufficient accuracy rates as measured by Transaction Editing System (TES) edits, claim action report volumes, and denials. The Medical Coder will identify potential compliance concerns and/or barriers toward timely completion of all tasks to the Coding Manager and will endeavor to work in collaboration with colleagues in Coding, Clinical Departments, Health Information Management, Information Technology, and Finance toward viable solutions.
Training will be conducted virtually from your home. This position is full-time (40 hours/week) Monday to Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00am – 5:00pm EST. It may be necessary, given the business need, to work occasional overtime or weekends.
*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.
Primary Responsibilities:
The following section contains representative examples of work that will be performed in positions allocated to this classification. Bassett Healthcare is a dynamic organization, and the environment can be fluid. Roles and responsibilities can often be expanded to accommodate changing patient or organizational needs and conditions as well as to tap into skills and talents of employees. Accordingly, employees may be asked to perform duties that are outside the specific functions that are listed.
Charge Capture
- Review charge capture documents, paper or electronic, for completeness and accuracy
- Reconcile collection of charges to daily census report or schedules depending on place of service
- Accurately indicate and link all ICD-10 diagnosis codes, procedure codes and modifiers on the charge document
- Prepare daily charge capture documents according to Bassett policies and procedures
- Process all pre-billing edits on a daily basis and complete each edit within 2 business days
- Ensure charges are posted within the following time lines: 4 days from date of service for Outpatient services and 7 days from date of service for Inpatient services by monitoring Lag Time Reports and working with practitioners and associated staff responsible for charge capture to meet those goals
Denial Management
- Process denials on a daily basis ensuring all requested timelines are met
- Ensure procedure and ICD-10 codes reflect documentation
Customer Service
- Respond to customer service questions and report recurring issues to management
- Work and communicate in a positive, cooperative manner with patients and their families when resolving customer service issues based on management observation and/or patient feedback
Competencies
- Attend all staff meetings
- Maintain current Coding Certification and active membership in local AAPC chapter, including participation in local events and meetings
- Have a good working knowledge of all hospital computer systems and coding tools available to assist with correct coding. This includes Epic’s Electronic Health Record application, MedAssets CodeCorrect application, and other department specific clinical/coding applications, e.g. CodeRyte
- Keep abreast of coding changes and reimbursement reporting requirements and raise concerns to Coding Manager for resolution
- Review and implement changes to departmental/site clinic sheets and charge documents to reflect current ICD-9 or ICD-10 in October, HCPCS and CPT’s in January
- Abide by Standards of Ethical Coding as set forth by the AAPC or AHIMA (depending on certification) and adhere to Official Coding Guidelines as set forth by CMS and the OIG
Coding Review and Reimbursement Resource
- Conduct annual and focused reviews
- Use interpersonal skills effectively to build and maintain cooperative working relationships with all levels and departments within the organization
- Based on management request, assists with the orientation, skill development and mentoring of employees new to the coding function
- Provide education to all providers within given specialty based on coding trends and will conduct new provider orientation
- Performs similar or related duties as requested or directed
- Performs other duties as requested and observed by supervisor or manager
You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction 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) OR equivalent years of work experience
- 1+ years of experience in hospital/physician coding and/or hospital/physician bill
- CPC (CPC-A; CPC-H or CPC-P are all acceptable), RHIT or CCS Certification
- Extensive knowledge of CPT, HCPCS, ICD-10 codes, anatomy and physiology and medical terminology
- Knowledge of coding rules and regulations for issues regarding medical record documentation, compliance and reimbursement, including medical necessity, claims denials, bundling issues and charge capture
Telecommuting Requirements:
- Required to have a dedicated work area established that is separated from other living areas and provides information privacy
- Ability to keep all company sensitive documents secure (if applicable)
- Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service
Physical and Work Environment:
- The position involves extensive work at computer station
