JOB DESCRIPTION AND DETAILS
The OptumHealth Behavioral Solutions (OHBS) PNI Coding Quality Analyst is responsible for coding and auditing services specific to administrative fraud, waste and abuse cases. This includes the analysis, documentation, explanation and translation of medical and behavioral diagnosis and procedures. The Medical Coder/Analyst will support the OHBS PNI in research, issues and inquiries that relate to their reviews and policies on Medical Coding/Auditing.
Conducts reviews on records that have been identified as suspicious and/or potentially fraudulent, utilizing most current reference materials to include, but not limited to: Current Procedural Terminology (CPT), Internal Classification of Disease (ICD-9/ICD-10) and Healthcare Common Procedure Coding System (HCPCs) guidelines
Documents Decisions on reviews through notations and enters notes in appropriate company systems
Ability to discuss and present on decisions made to appropriate internal and external individuals/groups
Coordinate with team members to understand trends and schemes related to billing issues/coding trends
To be considered for this position, applicants need to meet the qualifications listed in this posting.
2+ years of experience in coding and medical billing
Associates degree or related field experience
Clinical and/or coding expertise in a Physician office, SNF, ALF, Hospital setting, and/or billing/office
Strong oral and written communication skills
Strong organizational/time management skills and be able to work independently or as a team
Strong knowledge of CMS 1500 and UB04 data elements
Strong knowledge of ICD, CPT, HCPC and Revenue Codes
Ability to support heavy work load volume and meet unit standards while engaging multiple priorities
Current CPC or CCS-P Certification
Behavioral Health experience
Problem solving skills
Serves as a resource on moderately complex issues related to coding / billing
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