UnitedHealth Group

Compensation

Full Description

Optum 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 Caring. Connecting. Growing together. Position Overview This role is responsible for researching, defining, implementing, and testing requirements for Facility Claims as outlined by national sourcing. The position works closely with application teams to ensure requirements are accurately defined and administered. A key focus is the development and maintenance of Facility Medicare, Commercial, and Medicaid global data rulesets for products such as Claims Manager and CES. The role requires deep expertise in Facility regulatory guidelines and the ability to interpret these standards into precise edits and rules that ensure compliance and meet client needs. Responsibilities include creating and implementing rules, conducting comprehensive testing of edits and logic to validate functionality, and ensuring alignment with regulatory requirements. Solid expression development skills are essential, as the candidate will independently design, implement, and test all rule logic. Deliverables primarily support Claims Manager and CES, making accuracy and reliability critical to success. You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week. Primary Responsibilities: Demonstrated self-starter and independent individual contributor. Prioritizes and organizes own work to meet deadlines. Generally, work is self-directed and not prescribed Creating, documenting, and maintaining the content of Optum coding database to identify sources of edits Accurately research source information and interpret national reimbursement policies and coding guidelines for utilization in Optum coding products. Monitor Centers for Medicare & Medicaid Services (CMS) for Inpatient (MCE), Outpatient (OCE), NUBC, ASC fee schedule changes to develop/change regulatory system rules/edits. Hospital inpatient and outpatient coding subject matter expert (SME) Independent decision making related to correct coding and common practice standards Project lead for various coding related agendas Testing of current and future rule functionality Adapts departmental plans and priorities to address business and operational challenges Review, research and provide clinical support to potential and current clients. Product, service or process decisions are most likely to impact multiple groups of employees and/or customers Influences or provides input to forecasting and planning activities Works with less structured, more complex issues. Resolves problems and provides guidance to members of own team. Data-Driven Rules (DDRs) is a new rule delivery methodology which is delivered as part of the Knowledge Base (KB) outside of a formalized release as patterns (i.e., frequency, modifiers, revenue code, type of bill, ASC, etc.). This allows the release of new relationships and edits in a timelier manner. With these responsibilities, it is imperative that this role provide thought-leadership and overall subject matter expertise to this initiative Serves as a resource for others 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: 3+ years of Outpatient and/or Inpatient coding experience 3+ years of experience in health information management or related health care management 1+ years of experience with Medicare Claims processing for Outpatient Code Editor (OCE),Medicare Code Editor (MCE-inpatient) and/or National Uniform billing Requirements (NUBC) 1+ years of experience creating professional documentation such as writing business requirements, proposals, clinical requirements, etc. Preferred Qualifications: Medical coding certifications: RHIA, RHIT, CCS, or credentialed through AAPC with CPC or CPC-H 1+ years of experience with medical claims processing, appeals resolution, facility coding experience or reimbursement policy *All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you’ll find a far-reaching choice of benefits and incentives. The salary for this role will range from $89,900 to $160,600 annually based on full-time employment. We comply with all minimum wage laws as applicable. Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. At 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. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.