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Job Details

Senior Medical Coder - HCC


Medical Director


Ontario, California, United States

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 key challenge of this role centers around your ability to work quickly, accurately and independently. You'll be challenged with daily production goals as well as maintaining a high accuracy rate to achieve your quality goals.

If you are located in Palm Springs/Palm Desert/Ontario/Beaumont, you will have the flexibility to work remotely* as you take on some tough challenges.

Primary Responsibilities:

  • Receive assigned medical charts to code
  • Review medical charts electronically
  • Abstract and code diagnosis and documentation information
  • Document requested information from the medical record
  • Identify training needs, prepare summary reports and conduct coaching as appropriate for clinicians and other staff to improve the quality of the documentation to accurately reflect the burden of illness for our patients
  • Perform ongoing analysis of medical record charts for the appropriate coding compliance
  • Provides feedback to physician director, Care Management, Optum's hospitalist for concurrent admissions on the likely DRG code, DRG outlier status, and DRG reimbursement
  • Serves as a key contact and liaison with clinicians to answer coding questions
  • Provides individualized sessions with clinicians for specific coding issues based on medical chart audit results
  • Maintains database of admissions in which concurrent DRG feedback was provided
  • Upon discharge and claim submission, performs validation and analysis of concurrent DRG feedback
  • Provides updates and status reports to management on a weekly basis
  • Stays abreast of industry coding and compliance issues
  • Participates in coding / auditing discussions to ensure best practice efforts and processes are implemented ensuring maximum reimbursement through appropriate coding
  • Uses, protects, and discloses Optum patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards
  • Extensive use of electronic medical records in an ICD-10 environment is also required

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 or GED
  • Coding certification to include ONE of the following: CPC, CPC-H, CCS, CCS-P or CCA
  • 3+ years of medical coding experience
  • 1+ years of HCC coding Medicare risk adjustment
  • Experience working with CPT, ICD-10, and HCC Coding
  • Basic Microsoft office skills: Word, Excel, PowerPoint, Microsoft Teams, Webex, Zoom

Preferred Qualifications:

  • RHIA or RHIT Certifications
  • Facility based coding experience
  • Managed care experience
  • Experience with HEDIS
  • Pharmacology knowledge

Careers at OptumCare. We're on a mission to change the face of health care. As the largest health and wellness business in the US, we help 58 million people navigate the health care system, finance their health care needs and achieve their health and well-being goals. Fortunately, we have a team of the best and brightest minds on the planet to make it happen. Together we're creating the most innovative ideas and comprehensive strategies to help heal the health care system and create a brighter future for us all. Join us and learn why there is no better place to do your life's best work.(sm)

OptumCare is committed to creating an environment where physicians focus on what they do best: care for their patients. To do so, OptumCare provides administrative and business support services to both owned and affiliated medical practices which are part of OptumCare. Each medical practice part and their physician employees have complete authority with regards to all medical decision-making and patient care. OptumCare’s support services do not interfere with or control the practice of medicine by the medical practices or any of their physicians.

California Residents Only: The hourly range for California residents is $22.45 to $43.89. 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 employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.

Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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.

OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.