Coding Education Consultant – National Remote

$ 10,000 Sign-On Bonus for External Candidates

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.

Reporting to the Provider Education and Escalations Manager, the Coding Education Consultant is part of a team responsible for conducting coding audits for escalated claims and providing coding education to providers and facilities who are inaccurately billing.

This role will primarily focus on the presentation of medical coding content on common billing errors, performing audits on escalated claims, and providing feedback on completed claim audits. This position requires the coder to present/deliver coding education in a variety of settings both internally and externally: (not limited to) educational boot camps, expo event class, provider/facility offices, method of delivery is mainly via telephonic or virtual (i.e.: Webex) meetings.

This position is full-time, Monday – Friday. Employees are required to work during our normal business hours of 8:00am – 5:00pm. It may be necessary, given the business need, to work occasional overtime.

We offer 4 weeks of on-the-job training. The hours of training will be during our normal business hours.

You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

 

Primary Responsibilities:

• Create and deliver presentation materials to facilitate provider education
• Lead provider education meetings to drive issue resolution, including potential onsite provider meetings
• Apply principles of adult learning and training best practices to deliver effective and innovative training material
• Create supporting materials for learning activities (e.g., agendas, schedules, letters, audio/visual aids, etc.)
• Leverage/modify existing training solutions to meet current needs
• Act as a subject matter expert for internal and external partners in the form of assistance with medical coding, documentation requirements based off industry standards
• Ensures adherence to state and federal mandates for all coding guidance, applicable benefit language, medical & reimbursement policies, coding requirements and consideration of relevant clinical information
• Possesses strong decision-making skills on complex claim audits
• Analyze and interpret claims data and medical records/documentation to understand the historical activity and determine validity of the payment/denial on a claim
• Identifies aberrant billing patterns and trends, evidence of fraud, waste, or abuse, and recommends providers to be flagged for review
• Maintains and manages daily assignments, with accountability to quality, utilization, and productivity standards
• Discussing the findings as a collaborative team with UHN advocacy, UHC PPS and analyst before approaching the provider call
• Maintaining positive provider and network relationships
• Actively owning and resolving issues for Best in Class and / or high-profile providers encountered during education session
• Analyze data trends prior to education outreach to ensure provider billing errors are addressed in a holistic fashion
• Responsible for managing individual workload with a high emphasis on quality
• Assume additional responsibilities 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:

• Active Registered Nurse (RN) License
• Active Coding Certification (CPC, CIC, CCS, COC, RHIT, or RHIA)
• Must be 18 years of age OR older
• 5+ years of experience as a Certified Coder
• 5+ years of experience working in healthcare, including knowledge of industry terminology and regulatory guidelines
• 3+ years of experience providing formal training on medical coding
• 2+ years of customer service experience
• Fully proficient with Microsoft products such as Microsoft Word, Microsoft PowerPoint, and Microsoft Excel
• Ability to work Monday – Friday, during our normal business hours of 8:00am – 5:00pm

 

Preferred Qualifications:

• CDI Certification
• Coding Training Certification
• 3+ years of experience in Optum FWAE clinical operations as a clinical investigator OR similar role (i.e. appeals / reconsideration reviewer, Team Lead)
• Experience with FWAE processes and workflow management tools
• Fraud Investigational and / OR Auditing experience
• Managed care experience
• Knowledge of claims platforms

 

Telecommuting Requirements:

• Ability to keep all company sensitive documents secure (if applicable)
• Required to have a dedicated work area established that is separated from other living areas and provides information privacy
• Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service

 

Soft Skills:

• Strong written, verbal, analytical, organizational, time management, and problem-solving skills to balance multiple priorities
• Effective interpersonal, influence, collaboration and listening skills for success individually and in a team setting
• Ability to adapt in a dynamic and high-growth environment
• Ability to prioritize and manage multiple tasks in an ever-changing environment
• Proven ability to work in a team setting
• Proven ability to work independently

 

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

 

The salary range for this role is $71,600 to $140,600 annually based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

 

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

 

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.

 

 

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity / Affirmative Action employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

 

UnitedHealth Group is a drug – free workplace. Candidates are required to pass a drug test before beginning employment.

 

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