Optum, a global leader in healthcare technology, is dedicated to improving health outcomes by connecting individuals with essential care, pharmacy benefits, and data resources. Join a supportive culture of talented peers and comprehensive benefits, where your work directly contributes to advancing health optimization worldwide. This role offers a fantastic opportunity to make a tangible impact on the communities we serve.

We are seeking an experienced Senior Medical Coder to join our dynamic team. This position is crucial for ensuring the accuracy and completeness of medical records and claims processing. If you are passionate about healthcare and possess a keen eye for detail, we encourage you to apply.

Key responsibilities include meticulously verifying diagnosis, evaluation and management, and procedure codes for record completeness and accuracy. You will examine medical records for consistency with established CMS criteria and regulations, ensuring all documentation supports the diagnosis and treatment administered.

Responsibilities extend to reviewing diagnoses, procedures, supplies, and drugs using ICD10, CPT, and HCPCS classifications. You will also validate claim denial reasons, applying CMS coding policies and navigating internal claim processing platforms. Interpreting appeals, understanding complex or unusual coding scenarios, and tying denials directly to applicable CMS policies are essential.

Furthermore, you will ensure all provider arguments are reviewed and resolved with clear, concise narratives, including direct sourcing for denial or uphold decisions. Proficiency in navigating and understanding systems like COSMOS/Facets, ATS, CMS.gov, Outpatient Code Editor, and CESSAM edits is required. Compliance with all company policies and procedures is mandatory.

We require candidates to possess a Bachelor's Degree or demonstrate 5+ years of technical writing experience, coupled with at least 5 years of dedicated coding and auditing experience in E&M, CPT, and HCPCS, with a preference for denial coding expertise. Experience with spreadsheet and word processing software, such as Microsoft Excel and Word, is also essential.

Proven experience in client interactions and multispecialty coding, specifically in denial coding for E/M, ED, Surgery/OP/IP (any two out of six specialties), is highly valued. Demonstrated ability to manage and prioritize deliverables, work with minimal guidance, and seek clarification only for the most complex issues is expected.

Exceptional verbal and written communication skills, strong organizational abilities with a capacity for flexibility and working with ambiguity, and a proven meticulous attention to detail are critical for success in this role.