Credentialing Representative

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.

Schedule:

Monday to Friday, 8:00 am to 5:00 pm EST

Location:

Remote Nationwide You will enjoy the flexibility to telecommute
* from anywhere within the U.S. as you take on some tough challenges.

• 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 on a timely basis
• Utilize medical coding software programs or reference materials to identify appropriate codes
• Apply post-query response to make final determinations
• 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
• Provide information or respond to questions from medical coding quality audits
• Demonstrate basic knowledge of the impact of coding decisions on revenue cycle
• Attain and/or maintain relevant professional certifications and continuing education seminars as required
• Utilize and navigate across clinical software applications to assign medical codes or complete reviews
• Will be monitored and mentored to achieve removal of apprentice classification when appropriate
• Performs other duties as assigned

What are the reasons to consider working for United Health Group? Put it all together – competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include:

• Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays
• Medical Plan options along with participation in a Health Spending Account or a Health Saving account
• Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage
• 401(k) Savings Plan, Employee Stock Purchase Plan
• Education Reimbursement
• Employee Discounts Employee Assistance Program
• Employee Referral Bonus Program
• Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)
• More information can be downloaded at:

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear directions on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

• High School Diploma/GED (or higher)
• 2 years of healthcare provider credentialing experience
• 1 years of experience working with compliance workflows and processes, including NCQA policies and practices
• 1 years of experience in researching and applying government regulatory information
• Intermediate level of proficiency with MS Excel and Word

• Ability to work independently and maintain good judgment and accountability
• Demonstrated ability to work well with health care providers
• Strong organizational and time management skills
• Ability to…