Optum Coding Jobs (NOW HIRING)

Remote work from Illinois, Wisconsin, Indiana, and Iowa

Description

The Coding Specialist II reflects the mission, vision, and values of NM, adheres to the organization's Code of Ethics and Corporate Compliance Program, and complies with all relevant policies, procedures, guidelines and all other regulatory and accreditation standards.

The PB Coding Specialist II performs Current Procedural Terminology (CPT) and International Classification of Diseases, volume 10 (ICD10) coding through abstraction of the medical record with a focus on more complex encounters and/or has expertise with HCPCs procedural codes. Has deep understanding of disease process, A&P and pharmacology. Acts as a key collaborator with Providers and Clinical areas to ensure the medical record accurately reflects the patient's service. This position trains physicians and other staff regarding documentation, billing and coding, and performs various administrative and clerical duties to support the role's core function. Also demonstrates expertise to resolve Optum coding edits.

RESPONSIBILITIES

Description

* Utilizes technical coding expertise to reviews the medical record thoroughly, utilizing all available documentation abstract and code physician professional services and diagnosis codes (including anesthesia encounters, operative room and surgical procedural services, invasive procedures and/or drug infusion encounters). Additionally, may include coding for Evaluation and Management services, bedside procedures and diagnostic tests as needed.

* Follows Official Guidelines and rules in order to assign appropriate CPT, ICD10 codes and modifiers with a minimum of 95% accuracy.

* Ensures charges are captured by performing various reconciliations (procedure schedules, OR logs and clinical system reports).

* Provides documentation feedback to physicians.

* Maintains coding reference information.

* Trains physicians and other staff regarding documentation, billing and coding.

* Reviews and communicates new or revised billing and coding guidelines and information.

* Attends meetings and educational roundtables, communicates pertinent information to physicians and staff.

* Resolves pre-accounts receivable edits. Identifies repetitive documentation problems as well as system issues.

* Makes appropriate changes to incorrectly billed services, adds missing unbilled services, provides missing data as appropriate, corrects CPT and ICD9 codes and modifiers. Adds MBO tracking codes as needed.

* Collaborate with Patient Accounting, PB Billing, and other operational areas to provide coding reimbursement expertise; helps identify and resolve incorrect claim issues and is responsible for drafting letters in order to coordinate appeals.

* Acts as key point person for Revenue Cycle staff and Account Inquiry Unit staff in obtaining documentation (notes, operative reports, drug treatment plans, etc.). Provides additional code and modifier information to assist with appealing denials. May contact providers for peer-to-peer reviews.

* Meets established minimum coding productivity and quality standards for each encounter type.

* May perform other duties as assigned.

COMPETENCIES / PERFORMANCE EXPECTATIONS

* Please refer to NMHC Performance Standard Competencies.

* Maintains up-to-date knowledge, understands, and implements coding rule updates.

* Exceptional interpersonal skills, including the ability to establish and maintain effective relationships with patients, physicians, management, staff and other customers.

* Demonstrated customer service skills, including the ability to use appropriate judgment, independent thinking and creativity when resolving customer issues.

* Ability to effectively handle challenging situations.

* Ability to balance multiple priorities.

* Excellent verbal and written communication skills.

* Ability to use personal computers and select software applications.

* Ability to analyze data for decision making purposes.

* Strong computer skills, including Microsoft Office, Outlook and database entry.

* Ability to maintain a high degree of confidentiality.

* Ability to adapt to changes in work environment, delays or unexpected events.

* Demonstrates attention to detail and monitors own work for accuracy.

Qualifications

Required:

* Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT) or Certified Professional Coder (CPC) certification or Certified Coding Specialist (CCS).

* Zero (0) to two (2) years' experience in a relevant role.

* 94% accuracy on organization's coding test.

Preferred:

* Bachelor's degree or Associate's degree in a Health Information Management program accredited by the Commission on Accreditation for Health Informatics and Information Management Education (CAHIIM).

* Previous experience with physician coding.

Equal Opportunity

Northwestern Medicine is an equal opportunity employer (disability, VETS) and does not discriminate in hiring or employment on the basis of age, sex, race, color, religion, national origin, gender identity, veteran status, disability, sexual orientation or any other protected status.

Background Check

Northwestern Medicine conducts a background check that includes criminal history on newly hired team members and, at times, internal transfers. If you are offered a position with us, you will be required to complete an authorization and disclosure form that gives Northwestern Medicine permission to run the background check.  Results are evaluated on a case-by-case basis, and we follow all local, state, and federal laws, including the Illinois Health Care Worker Background Check Act.

Artificial Intelligence Disclosure

Artificial Intelligence (AI) tools may be used in some portions of the candidate review process for this position, however, all employment decisions will be made by a person. 

Benefits

We offer a wide range of benefits that provide employees with tools and resources to improve their physical, emotional, and financial well-being while providing protection for unexpected life events. Please visit our Benefits section to learn more.

Sign-on Bonus Eligibility (if sign-on bonus offered for position): Internal employees and rehires who left Northwestern Medicine within 1 year are not eligible for the sign on bonus. Exception: New graduate internal employees seeking their first licensed clinical position at NM may be eligible depending upon the job family. 

Required:

* Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT) or Certified Professional Coder (CPC) certification or Certified Coding Specialist (CCS).

* Zero (0) to two (2) years' experience in a relevant role.

* 94% accuracy on organization's coding test.

Preferred:

* Bachelor's degree or Associate's degree in a Health Information Management program accredited by the Commission on Accreditation for Health Informatics and Information Management Education (CAHIIM).

* Previous experience with physician coding.