|Employer:||Optum, a UnitedHealth Group Company
|Skills:||Coding,AHIMA,AAPC,Outpatient CPT,ICD-10,Medical Terminology
|Specialties:||ICD-10, CPT, HCPS, KPI
|Required Certifications:||AAPC,or AHIMA
|Required Experience:||3 to 4 years
|Location:|| Greeensburg 15601, PA, US
Who are we? Optum360. We’re a dynamic revenue cycle management organization. As part of the growing family of UnitedHealth Group, we’ll leverage our compassion, our talent, our resources and experience to bring financial clarity and a full suite of revenue management services to health care providers nationwide.
If you’re looking for a better place to use your passion, your ideas and your desire to drive change, this is the place to be. It’s an opportunity to do your life’s best work.(sm)
The Manager of Physician Coding is responsible for the oversight of documentation and coding processes within the EHMG physician practices and for providing support to the overall revenue cycle. The manager is accountable for ensuring proper reimbursement and compliance with coding guidelines and regulations, and will play an active role in the education of Physicians and staff including annual coding updates. The manager is expected to maintain a working knowledge of coding process, policy, procedures, and serves as subject matter expert for CPT, ICD-10 and coding principles in accordance with the most recent published regulations from CMS, AMA, ACOS, AAPC, and The Official Coding Guidelines. The position is responsible for advising leadership on impacts of regulatory and operational changes. Is expected to provide regular coding updates/summaries of quality measurements and productivity metrics and will maintain ongoing communication with revenue cycle leadership regarding coding workload, quality, productivity, and other coding specific guidelines. In addition, the Coding Manager is responsible for ensuring coding processes are conducted efficiently and in a high quality manner to meet Optum360 compliance program expectations and metrics.
***This is a telecommute role from PA and must be able to attend onsite meetings frequently in the Greensburg, PA office.***
•Monitor and remain apprised of all reimbursement programs and associated reporting requirements e.g. Medicare, Medicaid and commercial plans by reading and researching official transmittals, program memoranda and other official information on appropriate websites, trade journals or other publications. Utilize this information to support coding and documentation functions throughout the practices.
•Conduct routine audits of outpatient accounts for: ICD-10-CM & CPT/HCPCS coding, documentation in the medical record, transfer of clinical/coded data to the claim and monitor payment outcomes, including denials, suspended claims and return to provider RTP accounts
•Conduct and coordinate revenue cycle audits and analytical reviews on individual practices and assist the Central Billing Office in identifying and implementing revenue cycle improvement opportunities.
•Maintains appropriate audit processes e.g. standardized audit samples, proper reporting of audit findings including recommendations for improvement
•Oversees, develops and conducts delivery of coding and documentation education for physicians, physician extenders, residents and coders
•Maintains a current competency level for ICD-10-CM and CPT/HCPCS coding
•Understands and follows the Standards for Ethical Coding, internal policies relating to ethical conduct and confidentiality
•Participates in pertinent committees within the organization including: All scripts and Cerner (Electronic Health Record), Finance, ICD-10.
•Maintains performance dashboards for the coding staff, utilizes the KPI performance dashboards to identify and proactively solve for issues and identify opportunities.
•Ensures optimized use of technology tools (measured by AR day Lag, coder efficiency, work time, and all other KPI’s and SLA’s)
•Serve as subject matter expert for Medical Coding to improve the clinical knowledge and coding practice of the coding staff, and drives continuous quality improvement.
•Collaborate effectively and regularly with Coding Supervisor, Physicians, and Coding team to understand opportunities for coding quality improvement and responds to these opportunities with demonstrated results
•Lead, mentor and engage staff and serve as an escalation point for human resources issues
•Directs Supervisor and provides guidance on management and assignment of coding resources, work assignments, and deliverables within agreed upon scope, budget, and timeline.
•Responsible for hiring and human capital management of supervisor and coders
•Collaborate with Revenue cycle and quality management departments to resolve issues and support root cause resolution of process or coding issues.
•Develop and maintain all policies and procedures documentation related to coding operations
Opportunity to telecommute with some travel involved and work for a large Fortune 5 organization.
•Minimum of 3 years progressive management experience in a healthcare, Professional coding management experience preferred
•Required certifications include AHIMA or AAPC coding credentials for direct oversight of coding functions.
•Prior work focused on revenue cycle as it relates
•Extensive experience with various Electronic Health Records
•Bachelor’s Degree required, Health Information Management preferred
•Proficient in Microsoft office
•Medicare regulations and payment policies, Outpatient CPT Coding, ICD-10 and professional Evaluation and Management Coding
•Experience with Optum Revenue Cycle Technologies preferred
•Medical Terminology and Coding
•Healthcare Billing Experience
•Knowledge of Payor/Insurance Benefits
Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world’s large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)