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UnitedHealth Group Senior Medical Coder -Telecommute Eastern Time-zone preferred in Needham, Massachusetts

Landmark Health, part of the Optum and UnitedHealth Group family of businesses, was created to transform how healthcare is delivered to the most medically vulnerable members in our community. Our medical group provides home-based medical care to chronically ill patients, many of whom are ill-equipped to navigate our overwhelming healthcare system.

Do you want to make a difference in healthcare?

Because many of our patients are frail and elderly, we deliver care primarily in the comfort of their home. Our Program is also offered to eligible patients at no incremental financial cost to them. We are not a fee-for- service practice; we benefit economically only if we deliver high-quality patient outcomes and satisfaction. As a result, our clinical teams can spend quality-time caring for a smaller number of patients, giving all patients the space, respect, compassion and care they deserve.

At Landmark, our interdisciplinary teams collaboratively manage our complex patient panels. These teams are led by Physicians, Nurse Practitioners, and Physician Assistants, with supporting care provided by RN Nurse Care Managers, Social Workers, Pharmacists, Behavioral Health, and other employed team members.

Join Landmark to be part of a growing company full of purpose-driven, action-oriented, and compassionate team members working to dramatically transform healthcare for our communities.

Objective

This position plays a key role on the Landmark Health team by ensuring the accuracy, integrity, quality and compliance of coded patient data, identifying opportunities for quality improvement and leading market level education and training to providers and other key team members.

Primary Responsibilities:

  • Audit both aggregate coded data and individual encounter data to independently determine opportunities for education, training and documentation improvement for both individual providers and market level provider groups

  • Continually evaluate data for compliance with all applicable state and federal guidelines and internal Landmark policies and procedures

  • Participate in weekly market IDT meeting to give input to the team regarding coding and HCC’s for individual patient charts

  • Evaluate individual physician documentation practices to identify areas for improvement in quality and specificity. Initiate both group and one on one training and/or recommendations for additional areas of training

  • Create training modules and materials to be presented during formal education time - Landmark Way

  • Report individual provider and market level coding and documentation status and performance to the Coding Director and market leadership teams

  • Collaborate within the market team with Pod Leaders, General Managers and Regional Medical Directors to formulate appropriate coding and documentation support for individual providers, pods and/or the market region

  • Perform day to day coding on new providers, mentoring and training them until proficiency is achieved

  • Determine when proficiency is sufficient to transfer provider’s encounters to the Imagine coding team

  • Perform day to day coding on encounters for markets where domestic coding is contractually required

Coding Responsibilities:

  • Coders may not always perform day to day coding responsibilities, but when they do the following will be expectations:

  • Concurrent review of assessment data to validate the appropriate clinical ICD and CPT code(s)

  • Retrospective review of records and coded data for audit

  • Ensure code best suits the patient’s clinical condition according to coding regulations and patient’s recent medical care, site of that care and procedures

  • Query providers as necessary via written/verbal communications to obtain accurate and complete documentation to facilitate optimal coding

  • Ensure coding is done at the highest appropriate level of specificity supported by the medical documentation and monitor for opportunities to educate providers on documentation required for optimal specificity

  • Provides feedback and suggestions to providers regarding coding accuracy

  • Identifies trends and opportunities for improvement in clinical documentation and reports this information to the Director of Coding

  • Ensures compliance with and adheres strictly to all regulatory coding guidelines including:

  • ICD.9 and ICD.10 Official Guidelines for Coding and Reporting

  • AHA Coding Clinic for ICD.9 CM and ICD.10 CM

  • CMS Medicare Part C instructions and requirements for diagnostic coding

Supervisory

Medical Coding Compliance Specialists will report to the Director of Medical Coding

Competency

To perform the job successfully, an individual should demonstrate the following competencies:

  • Thorough knowledge of anatomy, physiology, pharmacology and medical terminology

  • Abide by AHIMA and/or AAPC coding Code of Ethics

  • Complies with Landmark policies, procedures

  • Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA)

  • Communicate professionally with Landmark providers (MD’s and NP’s) and interdisciplinary team

  • Ability to communicate status to leadership team

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:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

  • Coding Credential - at least one of the following: CPC, CCS, CCS-P, RHIT, or RHIA. 1+ years outpatient coding experience

  • ICD.10 certification through recognized national organization. Proficiency in ICD.10 coding

  • Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation

Preferred Qualifications:

  • 2+ years experience coding ICD.9/ICD.10 for HCC utilization. Familiarity with Medicare Risk Adjustment

  • Experience working with providers for documentation improvement

Physical Demands

Below are the physical requirements which are representative of those that must be met by the employee to successfully perform the essential functions of the job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

  • Regular requirement to sit; use hands to touch, handle or feel

  • Regular requirement to talk and listen

  • Occasional requirement to stand; walk and reach with hands and arms

  • Occasional requirement to lift and/or move up to 10 pounds

  • Vision abilities include close vision, peripheral vision, depth perception and ability to adjust focus

Work Environment

  • Below is a description of the work environment that the employee will encounter while performing the essential functions of the job

  • Work is generally in an office setting

  • Noise level is usually moderate

To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

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