Subject Matter Expert - IPDRG

Requisition Number: 2367214
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.
Under direct supervision, the Inpatient Coder is responsible for accurate coding of the professional services (diagnoses, procedures, and modifiers) from medical records in a hospital/clinic setting. Analyzing the medical record, assigning ICD-10-CM, and ICD-10-PCS codes with appropriate modifiers. Medical coding is performed in accordance with the rules, regulations and coding conventions of ICD-10-CM Official Guidelines for Coding and Reporting, ICD-10-PCS guidelines for reporting surgical services, Coding Clinic articles published by the American Hospital Association, and Client Coding Guidelines.
Primary Responsibilities:

• Identify appropriate assignment of ICD - 10 - CM and ICD - 10 - PCS Codes for inpatient services provided in a hospital setting and understand their impact on the DRG with reference to CC / MCC, while adhering to the official coding guidelines and established client coding guidelines of the assigned facility
• Abstract additional data elements during the Chart Review process when coding, as needed
• Adhere to the ethical standards of coding as established by AAPC and / or AHIMA
• Be able to code 1.5-2.5 charts per hour and meeting the standards for quality criteria
• Needs to constantly track and implement all the updates of AHA guidelines
• Provide documentation feedback to providers and query physicians when appropriate
• Maintain up-to-date Coding knowledge by reviewing materials disseminated / recommended by the QM Manager, Coding Operations Managers, and Director of Coding / Quality Management, etc.
• Participate in coding department meetings and educational events
• Review and maintain a record of charts coded, held, and / or missing
• Be an ideal team player who can work in a large group and provide inputs to the team for betterment of the team in terms of quality and productivity
• Under general supervision, organizes and prioritizes all work to ensure that records are coded and edits are resolved in a timeframe that will assure compliance with regulatory and client guidelines
• Adherence with confidentiality and maintains security of systems. Compliance with HIPAA policies and procedures for confidentiality of all patient records
• Demonstrates knowledge of security of systems and associated policies and procedures for maintaining the security of the data contained within the systems
• Comply with the terms and conditions of the employment contract, company policies and procedures, and any and all directives (such as, but not limited to, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regards to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment). The Company may adopt, vary or rescind these policies and directives in its absolute discretion and without any limitation (implied or otherwise) on its ability to do so

Required Qualifications:

• Life Science or Allied Medicine Graduates with certification from AAPC or AHIMA (CIC certification preferred)
• 5+ years of experience in multi-specialty IP DRG coding
• 5+ years of Acute Care Inpatient medical coding experience (hospital, facility, etc.)
• Experience with working in a level I trauma center and / OR teaching hospital with a mastery of complex procedures, major trauma ER encounters, cardiac catheterization, interventional radiology, orthopedic and neurology cases, and observation coding
• ICD - 10 (CM & PCS) and DRG coding experience

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.