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 diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start **Caring. Connecting. Growing together.** You will enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges. **Position Overview:** Researches, interprets and writes healthcare correct coding edits using regulatory requirements and guidance related to CMS, CPT/AMA and major payer policies. Complete analyses to identify providers with adherent billing patterns to flag for review. Possesses an overall understanding of all coding principles, including facility, provider and DME. **Position Details include but is not limited to:** + Write business rules and create provider flags which are programmed into system edits to detect fraudulent, aberrant and abusive coding and/or billing patterns + Update business rules/code lists for existing system edits based on industry changes or mandates from CMS, CPT/AMA and major payer coding and reimbursement updates and provide logic enhancements to IT + Monitor CMS and major payer coding and reimbursement policies + Utilizes systems and data to resolve business rule issues in the most effective and productive manner + Proof of concept development and data analysis of reports for potential edit development and provider flags + Manage the lifecycle of the coding and insight review claim edits and provider flags from concept to production + Analyze medical documents to evaluate potential issues of fraud and abuse + Coordinate activities with varying levels of leadership, insight review team, code edit team, legal counsel, internal and external customers, law enforcement and regulatory agencies, and medical professionals through effective verbal and written communications + Claims auditing to monitor for compliant coding and billing + Identify and make recommendations for enhancements to systems and processes 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:** + High School Diploma/GED (or higher) + Coding credential: RHIA, RHIT, CCS-P, or CPC + 2+ years of medical coding experience + Strong knowledge of ICD-CM, HCPCS, CPT and Revenue Codes + Intermediate level of proficiency with of Microsoft Office including Excel, Word and Outlook **Preferred Qualifications:** + Associates degree or Equivalent Experience in Health Information Management + 4+ years of physician and hospital medical claims experience + Knowledge of healthcare SIU + Knowledge of claims editing software and rules development + Excellent communication skills both verbal and written + Strong time management, problem solving, organizational, and analytical skills + Ability to work independently but also as a member of a team + Good interpersonal skills + Able to establish good customer relationships with trust and respect + Reimbursement policy and/ or claims software analyst experience + Knowledge of claims editing software and rules development + Excellent communication skills both verbal and written + Proven ability to review, analyze, and research coding and provider issues *All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy. The salary range for this role is $59,500 to $116,600 annually based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives. Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records. **_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._ _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._ \#RPO #GREEN