Full Time Optum Health Coding Risk Adjustment Jobs in Chicago, IL

As our Revenue Cycle Coding Edit Specialist, you will be a vital contributor to our revenue integrity and financial health. You'll focus on the critical task of inpatient record abstraction and precise medical coding, directly impacting data retrieval, analytics, reimbursement accuracy, and healthcare research. This remote opportunity is ideal for a dedicated professional eager to apply their expertise in HIM operations, navigating complex coding scenarios to optimize our revenue cycle management.

Every day you will assign diagnostic and procedure codes using a designated coding and abstracting system and industry-standard encoder software. You'll meticulously review and abstract information from inpatient records, demonstrating adept navigation across various Electronic Medical Records (EMRs) from multiple facilities. A significant part of your role will involve identifying and resolving potential coding edits and discrepancies to ensure claim accuracy and compliance, consistently meeting stringent quality and productivity coding standards.

To be successful in this role, you will possess established intermediate-level coding experience with a strong emphasis on inpatient coding guidelines and revenue cycle best practices. You must be a highly organized self-starter with exceptional problem-solving skills and the ability to work autonomously in a remote setting. Proficiency with various technical applications and EMR systems, sharp attention to detail, and a commitment to data quality are paramount for excelling in this critical financial coding and compliance-focused position.

• Accurately assigns codes from the current ICD classification systems for inpatient accounts, creates MS-DRG/APR-DRG assignments while adhering to coding guidelines, regulations and compliance plan
• Abstract additional data elements as identified by enterprise, such as administrative codes
• Review medical documentation and health information within various electronic medical or health systems to address coding claim edits and other requests from other departments, such as Patient Financial Services, in a timely manner ensuring DNFC KPI metrics are met
• Must be able to code all service lines of inpatient and outpatient accounts
• Ability to communicate effectively, stay organized, and demonstrate effective time management skills
• Adhere to the ethical standards of coding as established by AAPC and/or AHIMA

Required

• Education & Certification: High School Diploma or GED required, with an Associate's degree in HIM/HIT preferred. Must hold one of the following certifications: CCS, RHIT, or RHIA.
• Inpatient Coding Expertise: 2+ years of recent inpatient medical coding experience in a hospital or large multi-facility setting.
• Complex Case Experience: Proven ability to code complex conditions and procedures, ideally in a Level I/II trauma center or teaching hospital (e.g., cardiovascular, neurosurgery, orthopedics, NICU).
• Remote Work Proficiency: Demonstrated experience working effectively in a remote environment.
• Technical Acumen: Proficient with various encoder (e.g., Optum eCAC, Solventum) and EMR systems (e.g., Epic, Cerner, Meditech).
• Additional Preferred Credential: Clinical Documentation Improvement Professional (CDIP) certification is a plus.

Preferred

• 4-6 years 5 years of recent inpatient medical coding experience (hospital, large multi-facility organization, etc.), upon hire and
• Bachelors Other Bachelor’s degree in HIM, upon hire

Inspired by faith. Driven by innovation. Powered by humankindness. CommonSpirit Health is building a healthier future for all through its integrated health services. As one of the nation’s largest nonprofit Catholic healthcare organizations, CommonSpirit Health delivers more than 20 million patient encounters annually through more than 2,300 clinics, care sites and 137 hospital-based locations, in addition to its home-based services and virtual care offerings. CommonSpirit has more than 157,000 employees, 45,000 nurses and 25,000 physicians and advanced practice providers across 24 states and contributes more than $4.2 billion annually in charity care, community benefits and unreimbursed government programs. Together with our patients, physicians, partners, and communities, we are creating a more just, equitable, and innovative healthcare delivery system.