Senior Risk Adjustment Coder - Telecommute in the US

Careers at UnitedHealth Group

We're creating opportunities in every corner of the health care marketplace to improve lives while we're building careers. At UnitedHealth Group, we support you with the latest tools, advanced training and the combined strength of high caliber co-workers who share your passion, your energy and your commitment to quality. Join us and start doing your life's best work. SM


Compassion. It's the starting point for health care providers like you and it's what drives us every day as we put our exceptional skills together with a real feeling of caring for others. This is a place where your impact goes beyond providing care one patient at a time. Because here, every day, you're also providing leadership and contributing in ways that can affect millions for years to come. Ready for a new path? Learn more, and start doing your life's best work. SM

Our teams are helping people from around the world. We can bring out your best as you put your listening, analytical and problem solving skills to work in a setting that is geared to helping improve lives and enhance health care for millions. Here, you'll discover a wealth of pathways for professional growth within Customer Service, Billing, Claims, Enrollment & Eligibility and across our global economy. Join us and find out why this is the place to do your life's best work. SM

For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us and help people live healthier lives while doing your life's best work.(sm)

The Sr. Risk Adjustment Coder will provide Hierarchical Condition Category (HCC) coding services for outpatient and inpatient charts. This includes the analysis and translation of medical diagnoses with the ultimate goal of improvement in coding accuracy across the network. This position will evaluate clinical coding from medical records to ensure accurate coding of encounter data and recommends processes to ensure accurate and efficient coding practices. They will also assist in providing feedback regarding coding and reimbursement, participate in operational activities and work with network managers, medical director, market leader, stakeholders and other employees to ensure improvement in coding accuracy. The Sr. Risk Adjustment Coder will maintain high level (96%) coding accuracy and complete work within assigned queue in established timeframe.

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

Primary Responsibilities:
  • Support the OptumCare Utah Care Delivery Organization (CDO) and Mountain West Region (MWR) Coding Team
  • Process physician attestation forms and PCP visits at a minimum of 6 charts per hour
  • Perform inpatient chart reviews for Medical Management (MM)
  • Build and sustain effective relationships while working closely with manager, coding supervisor, coding team, Mountain West Region, Enterprise Clinical Performance, coding educators and network managers
  • Leverage understanding of disease process to identify and extract relevant details and data within clinical documentation and make determination or identify appropriate ICD-10 &/or CPT codes following CMS guidelines
  • Identify suspect / unreported HCC codes in the notes / records to reflect the severity of the patient's condition
  • Perform level one concurrent or retrospective coding quality reviews
  • Queries providers regarding missing, unclear, or conflicting health record documentation through the use of approved templates consistent with Optum Coding Guidelines
  • Resolve medical coding edits or billing item rejects in relation to code assignment
  • Work with assigned providers, network managers, medical director, market leader, stakeholders and/or other employees to ensure improvement in provider coding accuracy, as necessary
  • Perform the minimum number of coding quality reviews consistent with established departmental goals
  • Maintain a 96% quality audit accuracy rate
  • Attend internal meetings via WebEx as requested

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 education
  • Current Coding Certification with AAPC or AHIMA (CPC, CRC, CCS, RHIA, RHIT)
  • 3+ of experience years of ICD-10 Coding
  • 2+ years of experience in Risk Adjustment Coding
  • Proficiency Microsoft Office products: Outlook, Excel, Word

Preferred Qualifications:
  • Certified Risk Adjustment Coder (CRC) credentials
  • Experience working remotely with proven ability to prioritize tasks, meet goals and deadlines
  • Various Electronic Medical Record (EMR) experience
  • Experience with Attestations and physician queries
  • Familiar with AHA Coding Clinic
  • Familiar with systems: DataRAP, Alliance, Touch Works

To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies now require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles require full COVID-19 vaccination 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 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)

Colorado, Connecticut or Nevada Residents Only: The hourly range for Colorado residents is $20.77 to $36.88. The hourly range for Connecticut/Nevada residents is $22.93 to $40.58. Pay is based on several factors including but not limited to education, work experience, certifications, etc. 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

*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.

For more information on our Internal Job Posting Policy, click here.

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.

Job Keywords: risk adjustment coder, hcc, coding, cpc, icd-10, rhit , rhia, ccs, crc, cms, Telecommute, Telecommuter, Telecommuting, Work at Home, Work from Home, Remote, US