Medical Coding Senior Capability Analyst - Telecommute

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.(sm)

This position is responsible for researching, defining, implementing, and ensuring that clinical requirements are correctly defined and administered. Professional Commercial Guidelines are defined using national sourcing, such as Specialty Societies, CMS and the AMA/CPT. This position develops, completes quality acceptance testing and maintains data driven rules for the Commercial ruleset. Additionally, this position develops and maintains the KnowledgeBase of industry standard data to support such products as Claims Manager and CES. This position is responsible for responding to Client Clinical queries based on the data driven rule and KnowledgeBase development.

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

Primary Responsibilities:

• Research and create detailed edits with clinical perspective
• Testing of current and future rule functionality
• Review, research, and respond to client queries and/or concerns
• Monitor Centers for Medicare & Medicaid Services (CMS), Specialty Societies, AMA/CPT, NUBC, changes to develop/change regulatory system rules/edits to be passed on to clients
• Coding subject matter expert (SME)
• Prioritizes and organizes own work to meet deadlines
• Technical responsibilities around the Data Driven Rule (DDR) development. With these responsibilities, it is imperative that this role provide thought-leadership and overall subject matter expertise to this initiative
• Claims accuracy testing for current rule development
• Maintain current edits already developed (Quarterly KnowledgeBase release)
• Creation and maintenance publication deliverables (Documentation of Edit Rationale, Rationale Statements, Release notes, KnowledgeBase update reports, Change reports, etc.)
• Provide clinical support to potential and current clients to explain edits
• Product Assessment Clinical Review

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:

• Undergraduate degree or 4 years of professional equivalent working experience
• Proficient knowledge of CPT, ICD-10, and Medicare coding
• Professional certified coding certification
• Excellent verbal and written communication skills as well as ability to read and interpret documents such as regulations, technical specifications, client requirements and memoranda and procedure documentation manuals routinely available from regulatory agencies

Preferred Qualifications:

• A clinical nursing background (LPN or RN) with coding certification, credentialed coder, or comparable claims or coding experience
• 3 years of experience in health information management or related health care management
• Proficiency in medical claims processing, appeals resolution, facility/provider coding experience or reimbursement policy
• Knowledge of Commercial Claims processing
• Proven ability to prioritize and adapt to a fast-paced frequently changing environment is essential
• Proven ability to formulate independent rationale and document clearly and concisely for a multi-varied audience that has a varying levels of coding expertise
• Excellent reading comprehensions skills

To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.

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)

*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.

Colorado, Connecticut or Nevada Residents Only: The salary range for Colorado residents is $66,100 to $118,300. The salary range for Connecticut/Nevada residents is $72,800 to $129,900. Pay is based on several factors including but not limited to education, work experience, certifications, etc. 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.

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.