Senior Clinical Administrative Coordinator - Medical Coding

%3Cp%3E%3Cspan style=%22font-family:Tahoma, Geneva, sans-serif;font-size:10px;%22%3EOptum 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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start %3Cstrong%3ECaring. Connecting. Growing together.%3C/strong%3E%3C/span%3E%3C/p%3E%3Cp%3E%26nbsp;%3C/p%3E%3Cp%3E%3Cspan style=%22font-family:Tahoma, Geneva, sans-serif;font-size:10px;%22%3E%3Cstrong%3EHigh Level Overview of the Role%3C/strong%3E%3C/span%3E%3C/p%3E%3Cp%3E%3Cspan style=%22font-family:Tahoma, Geneva, sans-serif;font-size:10px;%22%3EPrepay Coding Investigation Consultant is responsible for investigating and resolving instances of healthcare fraud and abuse of medical providers. Coding Investigation Consultant uses information from a tip, member benefits, and medical records to document relevant findings. This position will achieve applicable targets and metrics as determined. %26nbsp;As a senior level staff person, this individual will provide mentoring, explanations, and feedback to others on difficult issues. %26nbsp;This position assists with projects both internal and external to the team. The Coding Investigation Consultant provides coding guidance to investigators on CPT codes relevant to an investigation. This position works with minimal guidance and seeks input on the most complex of tasks. Works with internal and external stakeholders to facilitate client requests and maintains compliance with regulatory requirements.%3C/span%3E%3C/p%3E%3Cp%3E%26nbsp;%3C/p%3E%3Cp%3E%3Cspan style=%22font-family:Tahoma, Geneva, sans-serif;font-size:10px;%22%3E%3Cstrong%3EPrimary Responsibilities:%3C/strong%3E%3C/span%3E%3C/p%3E%3Cul%3E%3Cli%3E%3Cspan style=%22font-family:Tahoma, Geneva, sans-serif;font-size:10px;%22%3EDay to Day:%3C/span%3E%3Cul%3E%3Cli%3E%3Cspan style=%22font-family:Tahoma, Geneva, sans-serif;font-size:10px;%22%3EReviews prepay claims with corresponding medical records to determine payment accuracy%3C/span%3E%3C/li%3E%3Cli%3E%3Cspan style=%22font-family:Tahoma, Geneva, sans-serif;font-size:10px;%22%3EReviews applicable policies, CPT guidelines and contracts as they pertain to clinical review%3C/span%3E%3C/li%3E%3Cli%3E%3Cspan style=%22font-family:Tahoma, Geneva, sans-serif;font-size:10px;%22%3EParticipates in regulatory meetings with client%3C/span%3E%3C/li%3E%3Cli%3E%3Cspan style=%22font-family:Tahoma, Geneva, sans-serif;font-size:10px;%22%3EParticipates in meetings with providers, advocates and legal to assist with provider abrasion%3C/span%3E%3C/li%3E%3Cli%3E%3Cspan style=%22font-family:Tahoma, Geneva, sans-serif;font-size:10px;%22%3EPerforms additional projects as needed by the business or Client; analyzes data; meets with internal and external stakeholders as necessary for resolution%3C/span%3E%3C/li%3E%3Cli%3E%3Cspan style=%22font-family:Tahoma, Geneva, sans-serif;font-size:10px;%22%3EContinuous monitoring of claim inventory in order to adhere to performance guarantees%3C/span%3E%3C/li%3E%3C/ul%3E%3C/li%3E%3Cli%3E%3Cspan style=%22font-family:Tahoma, Geneva, sans-serif;font-size:10px;%22%3EComply 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 regard 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%3Cspan style=%22line-height:115%;%22%3E%3Co:p%3E%3C/o:p%3E%3C/span%3E%3C/span%3E%3C/li%3E%3C/ul%3E
%3Cp%3E%3Cspan style=%22font-family:Tahoma, Geneva, sans-serif;font-size:10px;%22%3E%3Cstrong%3ERequired Qualifications:%3C/strong%3E%3C/span%3E%3C/p%3E%3Cul%3E%3Cli%3E%3Cspan style=%22font-family:Tahoma, Geneva, sans-serif;font-size:10px;%22%3EGraduate of minimum 4-year course of Allied Medical Health%3C/span%3E%3C/li%3E%3Cli%3E%3Cspan style=%22font-family:Tahoma, Geneva, sans-serif;font-size:10px;%22%3ECertified Professional Coder - CPC%3C/span%3E%3C/li%3E%3Cli%3E%3Cspan style=%22font-family:Tahoma, Geneva, sans-serif;font-size:10px;%22%3E1+ years clinical/coding experience (surgical, hospital, clinic settings).%3C/span%3E%3C/li%3E%3Cli%3E%3Cspan style=%22font-family:Tahoma, Geneva, sans-serif;font-size:10px;%22%3E1+ years of BPO experience%3C/span%3E%3C/li%3E%3Cli%3E%3Cspan style=%22font-family:Tahoma, Geneva, sans-serif;font-size:10px;%22%3ECPT %26amp; ICD coding experience required or %26nbsp;must pass AAPC CPC Certification provided by Optum%3C/span%3E%3C/li%3E%3Cli%3E%3Cspan style=%22font-family:Tahoma, Geneva, sans-serif;font-size:10px;%22%3EThorough knowledge of PC based software%3C/span%3E%3C/li%3E%3Cli%3E%3Cspan style=%22font-family:Tahoma, Geneva, sans-serif;font-size:10px;%22%3EDemonstrates critical thinking, problem solving, and analytical skills%3C/span%3E%3C/li%3E%3C/ul%3E%3Cp%3E%26nbsp;%3C/p%3E%3Cp%3E%3Cspan style=%22font-family:Tahoma, Geneva, sans-serif;font-size:10px;%22%3E%3Cstrong%3EPreferred Qualifications:%3C/strong%3E%3C/span%3E%3C/p%3E%3Cul%3E%3Cli%3E%3Cspan style=%22font-family:Tahoma, Geneva, sans-serif;font-size:10px;%22%3EGraduates of Allied Medical Health (Registered Nurse/Physiotherapist/Radiologic Technologist/ Pharmacist)%3C/span%3E%3C/li%3E%3Cli%3E%3Cspan style=%22font-family:Tahoma, Geneva, sans-serif;font-size:10px;%22%3EExperience with health insurance billing/coding%3C/span%3E%3C/li%3E%3Cli%3E%3Cspan style=%22font-family:Tahoma, Geneva, sans-serif;font-size:10px;%22%3EAbility to prioritize and manage multiple tasks%3C/span%3E%3C/li%3E%3Cli%3E%3Cspan style=%22font-family:Tahoma, Geneva, sans-serif;font-size:10px;%22%3EProven ability to work in a team setting%3C/span%3E%3C/li%3E%3Cli%3E%3Cspan style=%22font-family:Tahoma, Geneva, sans-serif;font-size:10px;%22%3EProven excellent oral and written communication skills and presentation skills.%3C/span%3E%3C/li%3E%3C/ul%3E%3Cp%3E%26nbsp;%3C/p%3E%3Cp style=%22text-align:center;%22%3E%3Cspan style=%22font-family:Tahoma, Geneva, sans-serif;font-size:10px;%22%3E%3Ci%3EAt 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.%3C/i%3E%3Cspan style=%22line-height:115%;%22%3E%3Co:p%3E%3C/o:p%3E%3C/span%3E%3C/span%3E%3C/p%3E