Research Analyst

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:

• Work on ICD-10 update and maintenance project
• Review all LCD and NCD policies maintained by CMS at least once each two-week production cycle to identify Contractor revisions to policies, new policies and retired policies.
• Edit the policy data using the database to assure that accurate and current policy data is delivered to our clients.
• Communicate with onshore stakeholders on a regular basis.
• Research and create policy appropriate code relationships and billing edits as specified in the data requirements for Clients requiring Medicare Data. Create reimbursement related edits like Medical necessity, Modifiers, frequency, POS etc. based on policy language and interpretation.
• Develop complex coding/clinical relationships in an intelligent database, maintain approx. 3500 LCD/NCD  policies in bi-weekly production cycle.
• Work on Medicaid/PQRS/other value add projects as required
• 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:

• Graduates (BAMS, BHMS, BPH, B.Sc. or equivalent) with coding certification(must) like CPC/CPC-H, CCS/CCS-P from AAPC/AHIMA or equivalent
• 2+ years of experience in medical Coding, Claims Reimbursement, Denial management (preferably post-certification)

Additional Job Information:

• Solid clinical acumen and analytical abilities
• Excellent communication skills
• Tech savvy with good MS office 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.