Identify appropriate assignment of ICD 10 CM and ICD 10 PCS Codes for inpatient services provided in a hospital setting and understand their impact on the DRG with reference to CC/MCC, while adhering to the official coding guidelines and established client coding guidelines of the assigned facility Identify appropriate assignment of CPT and ICD 10 Codes for outpatient sur

Responsible for greeting and welcoming patients in person. Provides a standard registration process by collecting demographic and financial data and enter information into an electronic medical record. Primary Responsibilities Greets and welcomes patient in person Collects demographic and insurance information Checks in or interviews patient to complete appropriate paperw

Create, manage, and respond to support tickets submitted by customers experiencing challenges with Contact center platform Provide exceptional omnichannel customer support by gathering and interpreting customer challenges Act as a technical liaison or subject matter expert in supporting cross functional issues Support the Technical Support Specialist in advanced trouble s

Lead the Case Management Operational teams for dedicated Optum client accounts for onsite delivery and outcomes. Accountable to meeting or exceeding operational and contract Service Level Agreements. Establishes and maintains service roadmaps to develop an integrated, innovative solution across all Care Management services. Provides input to consulting leadership for the

Provide coding quality auditing services to ensure compliance with Optum and CMS coding guidelines and accuracy of coding data reported Maintain compliance with Optum Coding Guidelines/policies. The minimum productivity goal is set by project, with minimum 96% coding accuracy rate required You'll be rewarded and recognized for your performance in an environment that will

Analysis and documentation Identifies and defines business requirements Constructs workflow charts and diagrams Validates resource requirements and develops basic cost estimate models Manages complex requirement conflicts, and assists associate and intermediate level Business Analysts with moderately complex to complex requirement conflicts Implements, modifies, tests, an

Assists in documenting standard operating procedures and business rules for the department Communicates with superiors, peers, employees, internal and external customers, and others, as appropriate, on a regular basis, assuring proper flow of information Is responsible for supporting staff that work remotely Manage in coming documentation and ensure it is routed to the co

Conduct MS DRG and APR DRG coding reviews to verify the accuracy of DRG assignment and reimbursement with a focus on overpayment identification Expert knowledge of and the ability to identify the ICD 10 CM/PCS code assignment, appropriate code sequencing, present on admission (POA) assignment, and discharge disposition, in accordance with CMS requirements, ICD 10 Official

Oversee detailed data analytics and financial projections (e.g., MicroStrategy, Excel) and translate findings to operational stakeholders Perform project / program management activities, such as monitoring client scope, creating and tracking deliverables, creating status reports, identifying and mitigating risks, managing resource plans, and monitoring successful achievem

Meet with clients that lack funding for SNF stay; assist with/facilitate application to Medical Assistance, application for Long Term Care and/or application to State Medical Review Team (SMRT) including securing forms, documentation and verifications required Submission and tracking of Medicaid applications Contact county and state offices regarding application status; p

Identify appropriate assignment of ICD 10 CM and ICD 10 PCS Codes for inpatient services provided in a hospital setting and understand their impact on the DRG with reference to CC/MCC, while adhering to the official coding guidelines and established client coding guidelines of the assigned facility Identify appropriate assignment of CPT and ICD 10 Codes for outpatient sur

Focus on outpatient Commercial, Medicaid and Medicare behavioral health services Conducting outpatient reviews to determine appropriate care Assessing if member care meets coverage guidelines Shaping member treatment in partnership with providers to ensure best practices Administering benefits and reviewing treatment plans You'll be rewarded and recognized for your perfor

Conduct in home assessments including an evaluation of past medical history, review of systems, medication reconciliation, vital signs, and comprehensive physical exam Perform evidence based practice screenings including point of care testing (as appropriate) Identify diagnoses to be used in care management and active medical management in the furtherance of treatment For

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, c

Focus on implementation and operational aspects of assigned Optum markets utilizing Cozeva Act as a liaison between Optum markets, Cozeva (Vendor) and other stakeholders (data teams, health plans) Leads complex projects that require cross functional coordination Responsible for issue management and facilitate solutioning to improve Cozeva adoption Create, maintain and com