Certified Coder – Risk Adjustment (Hybrid in SD)

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Position Summary

Member of the Performance and Risk Adjustment team.  Conducts chart review to code for diagnoses and quality.  Monitors performance and participates in improvement initiatives in conjunction with Provider Relations, health plans and providers.
 

Primary Responsibilities:

• Generates reports for department workflow, production, quality monitoring and performance improvement.  Participates in formulating improvement initiatives/solutions and assists with execution
• Reviews AWVs and other charts for HCC diagnoses and quality codes and processes them into the tracking programs.  Recommends training opportunities and participates in provider training as needed.  Audits and interfaces with outside coding vendors
• Participates in webinars, conferences and conducts research as needed to stay abreast of IHA/NCQA/CMS requirements
• Serves as the user expert for software systems.  Audits software accuracy from time to time and participates in testing.  Attends user meetings and reports systems issues to the vendor
• Tracks and submits audit data for program compliance
• Performs other duties as assigned

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:

• Associate’s Degree with equivalent combination of experience in healthcare and/or information systems
• Completed coursework in coding
• Coding certification
• 3+ years of experience in the healthcare industry
• Experience working with CPT and ICD-9 codes and reading claims forms/reports
• Knowledge of managed care concepts and healthcare delivery systems; understanding of health insurance industry and products
• Proven solid computer literacy, including competence with database and spreadsheet programs. Microsoft Office products familiarity
• Proven excellent organizational and interpersonal skills
• Proven organized self-starter with good follow through.  Ability to work with changing priorities and varying deadlines

Additional Position Evaluation Factors

• Impact of Decisions: Errors may have serious effects and could be costly
• Internal/External Contacts: This position interacts with both internal and external clients.  Examples of this are vendors, auditors, association staff and providers on occasion.

• Supervision Given/Received: Non supervisory reports to the Director of Network Management.

   

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.  

OptumCare  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.

OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment