senior Medical Coder - quezon city, ncrUnitedHealth Group

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.(sm)
This is Supervisor Role which was approved to support expectation of additional volumes for 2021. This team will be responsible for conducting medical record reviews. Team will conduct medical records review according to the clinical review guidelines and will take allow/deny decision on claims. Business Metrics include Quality, Productivity, Claim Process TAT and True Positive Rate support volume / demand of cases per Month.
Primary Responsibilities:
Leverage understanding of disease process to identify and extract relevant details and data within clinical documentation and make determinations or identify appropriate medical codes
Utilize resources and reference materials (e.g., on-line sources, manuals) to identify appropriate medical codes and reference code applicability, rules, and guidelines
Apply understanding of relevant medical coding subject areas (e.g., diagnosis, procedural, evaluation and management, ancillary services) to assign appropriate medical codes
Apply understanding of basic anatomy and physiology to interpret clinical documentation and identify applicable medical codes - Identify areas in clinical documentation that are unclear or incomplete and generate queries to obtain additional information
Follow up with providers as necessary when responses to queries are not provided in a timely basis
Utilize medical coding software programs or reference materials to identify appropriate codes
Make Medical Coding Determinations
Read and interpret medical coding rules and guidelines to make decisions (e.g., exclusions, sequencing, inclusions) - Apply post-query response to make final determinations
Make determinations on medical charting and take initiative to complete reviews independently to avoid delays in the process
Apply relevant Medical Coding Reference, Federal, State, and Professional guidelines to assign and record independent medical code determinations
Manage multiple work demands simultaneously to maintain relevant productivity and turnaround time standards for completing medical records (e.g., charts, assessments, visits, encounters)
Resolve medical coding edits or denials in relation to code assignment
Maintain Medical Coding Quality Standards
Provide information or respond to questions from medical coding quality audits
Perform medical coding audits to evaluate medical coding quality
Review medical coding audit results -Follow steps per agreement with medical coding audit results to resolve discrepancies -Provide resources and information to substantiate medical coding audit findings
Educate and mentor others to improve medical coding quality
Demonstrate Coding-Related Business and Technical Knowledge C) Fully Proficient - Apply understanding of National Correct Coding Edits to the coding process
Demonstrate understanding of National and Local coverage determinations
Demonstrate basic knowledge of the impact of coding decisions on revenue cycle
Follow relevant professional code of ethics consistent with required certifications
Attain and/or maintain relevant professional certifications and continuing education seminars as required -Leverage relevant computer software programs (e.g., Microsoft Office) to record information, analyze data, or communicate with others -Utilize and navigate across clinical software applications to assign medical codes or complete reviews
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:
College graduate of any Medical Allied course
Active CPC license - With at least 1 year of TL Coding Experience
Preferred Qualification:
BSN Graduate
Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system 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: Optum is an Equal Employment Opportunity 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.
Optum is a drug-free workplace. © 2021 Optum Global Solutions (Philippines) Inc. All rights reserved.
Job Keywords: Senior Medical Coder, Assistant Manager, Team Leader, Medical Coding Supervisor, Medical Coding Team leader, Quezon City, NCR, National Capital Region
UnitedHealth Group

Quezon City, Metro Manila
Permanent
Full-time