Coding Support Subject Matter Expert

This position is National Remote. You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Explore opportunities with Optum, in strategic partnership with ProHealth Care. ProHealth Care is proud to be a leader in health care services, serving Waukesha County and the surrounding areas for more than a century. Explore opportunities across the full spectrum of care as you help us improve the well-being of the community with your skills, compassion and innovation. Be part of a collaborative environment that strives for excellence, nurtures respect and ensures high-quality care delivery to our patients. Join us in making an impact as an Optum Team Member supporting Pro Health Care and discover the meaning behind Caring. Connecting. Growing together.

The Coding Support Subject Matter Expert (SME) serves as a vital resource within their respective health systems, offering expert level guidance and clarification on coding-related questions and issues. This role supports both coders and providers, ensuring accurate and compliant clinical documentation and coding practices across the organization. The SME uses their extensive knowledge of coding systems (e.g. ICD-10, CPT, HCPCS), payer requirements, and industry standards to respond to inquiries promptly and thoroughly.

Additionally, the SME proactively identifies trends, knowledge gaps, or recurring issues that signal the need for broader education or systemic improvements. This role plays a key part in promoting coding accuracy, compliance, and optimal revenue integrity.

This position is full time (40 hours / week), Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00 am - 5:00 pm. It may be necessary, given the business need, to work occasional overtime.

This will be paid on-the-job training. The hours of training will be aligned with your schedule.  

Primary Responsibilities:

• Serve as a liaison between coding teams and providers, delivering expert guidance to resolve inquiries and concerns
• Collaborate with Edits and Denials teams to analyze trends and implement educational initiatives or system edits to address recurring issues
• Partner with clinical leadership during the introduction of new services to ensure accurate documentation and coding compliance
• Participate in specialty and physician group meetings on a quarterly basis to provide targeted coding education and respond to ad hoc inquiries
• Deliver comprehensive coding and documentation training for all newly onboarded providers
• Provide annual education to providers on code set updates to maintain compliance and accuracy
• Conduct annual provider audits to validate charges and supporting documentation, while identifying potential revenue opportunities
• Provide targeted education and follow-up audits for providers who do not meet established quality standards
• Perform ad hoc audits in response to client requests or identified concerns
• Educate coders and providers on audit findings and emerging trends to promote continuous improvement
• Assist coders and/or supervisors as needed on rebuttals for tri-annual audits
• Other duties / projects 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:

• High School Diploma / GED OR equivalent work experience
• AHIMA or AAPC coding credentials (e.g., CCS, CPC, RHIT, RHIA)
• Must be 18 years of age OR older
• 5+ years of coding experience in a healthcare setting with evaluation, Management and experience in one or more of these specialties (Allergy, Audiology, Behavioral Health, Dermatology, Diabetes Management, Endo, ENT,  Maternal Fetal Medicine, Neurology, OB/GYN, Occupational Health, Palliative/SNF, Podiatry, Pulmonary/Intensivist/ID Pulmonary/Intensivist/ID Radiology, Urology, Wound)
• Understanding of ICD-10, CPT, HCPCS and official coding guidelines
• Experience with researching and interpreting complex coding guidelines and payer policies
• Detail oriented with critical thinking and problem-solving skills
• Ability to work full time (40 hours / week), Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00 am - 5:00 pm. It may be necessary, given the business need, to work occasional overtime

Preferred Qualifications:

• Experience with providing coding support or education
• Experience with Professional-fee IP surgery Coding
• Familiarity with Epic
• Knowledge of Medicare and commercial payer reimbursement methodologies
• Experience with physician education or clinical documentation improvement (CDI)

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:

• Exceptional communication skills, both verbal and written

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

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $28.94 - $51.63 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

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.

UnitedHealth Group 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.

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

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