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Optum Encoder information

What is the difference between Optum Encoder vs Medical Coder?

AspectOptum EncoderMedical Coder
CertificationsTypically requires coding certifications like CPC or CCSOften requires CPC, CCS, or similar certifications
Work EnvironmentHealthcare facilities, insurance companies, remote optionsHospitals, clinics, insurance companies, remote work common
Industry UsageUsed mainly in healthcare and insurance sectorsWidely used across healthcare providers and insurance
Job ResponsibilitiesEncoding medical records for billing and documentationAssigning standardized codes to medical diagnoses and procedures

Both Optum Encoder and Medical Coder roles involve medical coding, often requiring similar certifications and working in healthcare environments. While Optum Encoder may be specific to Optum's systems and processes, Medical Coder is a broader role found across many healthcare organizations. Understanding these similarities helps in choosing the right career path or job search focus.

What are the key skills and qualifications needed to thrive as an Optum Encoder, and why are they important?

To excel as an Optum Encoder, you need a solid understanding of medical coding systems (such as ICD-10, CPT, and HCPCS) and typically a certification like CPC or CCS. Familiarity with Optum’s 3M Encoder software, electronic health records (EHRs), and hospital information systems is also crucial. Attention to detail, analytical thinking, and effective communication are vital soft skills for ensuring coding accuracy and collaborating with clinical and billing teams. These abilities are important to ensure precise coding, regulatory compliance, and optimal reimbursement for healthcare services.

What are Optum Encoders?

Optum Encoders are specialized healthcare professionals who use Optum's medical coding software to accurately translate clinical documentation into standardized medical codes. These codes are used for billing, insurance claims, and maintaining patient records. Optum Encoders play a critical role in ensuring that healthcare providers receive proper reimbursement and comply with regulatory requirements. They must be knowledgeable about medical terminology, coding guidelines, and healthcare regulations. Their work helps streamline administrative processes and improve data quality in the healthcare industry.

What are some common challenges faced by Optum Encoders when working with complex medical records?

Optum Encoders often encounter challenges such as interpreting incomplete or ambiguous clinical documentation, keeping up-to-date with evolving coding standards, and ensuring high levels of accuracy under tight deadlines. Collaboration with healthcare providers and coding auditors is frequently required to clarify information and resolve discrepancies. Staying detail-oriented and proactive in seeking clarification helps maintain compliance and reduce errors, while also providing opportunities to learn and grow in the role.
What are popular job titles related to Optum Encoder jobs in Illinois? For Optum Encoder jobs in Illinois, the most frequently searched job titles are:
What job categories do people searching Optum Encoder jobs in Illinois look for? The top searched job categories for Optum Encoder jobs in Illinois are:
What cities in Illinois are hiring for Optum Encoder jobs? Cities in Illinois with the most Optum Encoder job openings:
Optum Encoder jobs near you
Market Manager Revenue Cycle CDI

Market Manager Revenue Cycle CDI

CommonSpirit Health

Chicago, IL • Remote

$47.52 - $78.41/hr

Full-time

Re-posted 27 days ago

CommonSpirit Health rating

7.1

Company rating: 7.1 out of 10

Based on 521 frontline employees who took The Breakroom Quiz

374th of 886 rated healthcare providers

Job description


Job Summary and Responsibilities

As our Market Manager, Revenue Cycle, CDI you will provide strategic oversight of CDI (Clinical Documentation Improvement) teams, holding them accountable to optimal performance within our revenue cycle management framework. This critical role ensures the overall accuracy and compliance for all CDI functions, directly impacting the financial health and operational integrity of CommonSpirit Health.

Every day you will develop and implement strategic plans designed to achieve CommonSpirit Health (CSH) enterprise Key Performance Indicators (KPIs). You will analyze complex data, generating insightful monthly KPI performance reports and dashboards for executive leadership. Furthermore, you will act as a vital liaison between physicians, coding teams, and clinical quality departments, fostering collaborative relationships essential for the accuracy and integrity of the inpatient medical record and optimizing clinical documentation processes.

To be successful in this role, you will need a strong background in revenue cycle operations, clinical documentation improvement, and healthcare data analytics. We are seeking a leader with proven experience in managing CDI teams, a deep understanding of healthcare compliance and coding guidelines, and the ability to drive strategic initiatives that enhance financial performance and clinical data accuracy across a large healthcare system.

  • CDI Team Oversight: Oversees the Clinical Documentation Integrity (CDI) team, ensuring optimal performance, compliance with regulations, and meeting productivity and accuracy standards.
  • Strategic Planning & Communication: Assists in strategic planning, develops presentations for leadership, and communicates effectively to resolve complex issues and deliver presentations.
  • Provider Education & Training: Participates in patient care teams/committees to educate on documentation guidelines and oversees the orientation of new providers to the CDI program.
  • Reporting & Collaboration: Prepares and presents CDI monitoring reports to leadership and collaborates with physicians, quality, and coding teams for continuous improvement.
  • Process Improvement & Leadership: Leads CDI department meetings, drives process improvement projects, and fosters a professional, team-oriented environment.
  • Resource Management & Support: Ensures managers have necessary tools, supports accountability, and can troubleshoot remote computer issues effectively.
Job Requirements

Required 

  • Associate of Nursing with 4-6 years
  • Associate's degree HIM or related field, Current RN license and/or certification from AHIMA (CDIP) or ACDIS (CCDS) to be maintained
  • Five (5) recent management of hospital-based CDI teams (hospital, large multi-facility organization, etc.)
  • Previous experience effectively managing remote teams
  • Experience with various encoder and EMR systems (Optum eCAC, Solventum, EPIC, Cerner, Meditech)
  • Registered Nurse
  • Clinical Documentation Improvement Professional (CDIP)

Preferred

  • Bachelors of Science in Nursing (BSN)
  • Bachelors Other or Bachelor’s degree in HIM  
Where You'll Work

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.

Qualifications:

Required 

  • Associate of Nursing with 4-6 years
  • Associate's degree HIM or related field, Current RN license and/or certification from AHIMA (CDIP) or ACDIS (CCDS) to be maintained
  • Five (5) recent management of hospital-based CDI teams (hospital, large multi-facility organization, etc.)
  • Previous experience effectively managing remote teams
  • Experience with various encoder and EMR systems (Optum eCAC, Solventum, EPIC, Cerner, Meditech)
  • Registered Nurse
  • Clinical Documentation Improvement Professional (CDIP)

Preferred

  • Bachelors of Science in Nursing (BSN)
  • Bachelors Other or Bachelor’s degree in HIM  
Employment Type: Full Time

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