Join Optum, a global leader dedicated to improving health outcomes through technology and compassionate care. We connect individuals with the resources they need to thrive, fostering a culture of inclusion and continuous growth. As part of our team, you'll contribute to advancing health optimization worldwide.

Our mission is to make healthcare work better for everyone. We are committed to equitable care and addressing health disparities. Come be a part of our journey to make a significant impact on the communities we serve.

As a Senior Medical Coder, your primary role involves meticulously verifying the accuracy of diagnosis, evaluation and management, and procedural codes within medical records. You will review and examine all components of patient charts to ensure completeness and adherence to established coding standards and regulations.

Key responsibilities include validating billed services for consistency and accuracy according to CMS criteria. You will also be instrumental in the appeal process, scrutinizing claim denial reasons and logic within our internal platforms. This involves interpreting appeals, validating claim processing, and precisely linking denials to applicable CMS policies, thereby determining whether a denial should be upheld or overturned.

We are seeking candidates with a Bachelor's Degree and at least 5 years of experience in medical coding and auditing, particularly in E&M, CPT, and HCPCS, with a preference for denial coding expertise.

Ideal candidates will possess experience in client interactions and multispecialty coding, with exposure to denial coding in areas such as E/M, ED, or Surgery. Proficiency in Microsoft Excel and Word is essential. You should demonstrate a strong ability to manage priorities, work independently with minimal supervision, and possess excellent verbal and written communication skills.

Preferred qualifications include a coding certification (CPC, CCS, RHIT, etc.) or a commitment to obtaining one. Familiarity with healthcare industry code sets and knowledge of denials, Medicare, and Medicaid policies are highly beneficial.