Senior Medical Coder

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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

The Ancillary Coding Specialist is responsible for accurately reviewing, analyzing, and assigning medical codes for ancillary services including laboratory, radiology, pharmacy, therapy, and other outpatient/diagnostic services. The role ensures compliance with coding guidelines, payer regulations, and organizational policies to support accurate billing and reimbursement.Medical coding is performed in accordance with the rules, regulations and coding conventions of ICD-10-CM Official Guidelines for Coding and Reporting, CPT guidelines for reporting professional and surgical services, CMS updates, Coding Clinic articles published by the American Hospital Association, assigning codes from HCPCS code book for supplies and equipment, NCCI Edits, and Client Coding Guidelines.

Primary Responsibilities

• Review and assign CPT, HCPCS, and ICD-10-CM codes for ancillary services across multiple client projects
• Ensure coding is compliant with client guidelines, payer requirements, CMS regulations, and internal SOPs
• Achieve and maintain defined productivity (charts per hour/day) and quality targets as per BPO standards
• Work on multiple specialties such as: Laboratory, Radiology, Infusion/Pharmacy, Therapy (PT/OT/ST)
• Analyze and resolve coding edits, denials, and rejections within turnaround time (TAT)
• Adhere to Service Level Agreements (SLAs) and turnaround timelines
• Perform client-specific documentation validation to ensure medical necessity and correct coding
• An ideal team player who can work in a large group and provide inputs to the team for betterment of the team in terms of quality and productivity
• Under general supervision, organizes and prioritizes all work to ensure that records are coded, and edits are resolved in a timeframe that will assure compliance with regulatory and client guidelines
• Adherence with confidentiality and maintains security of systems
• Compliance with HIPAA policies and procedures for confidentiality of all patient records
• Comply with the terms and conditions of the employment contract, company policies and procedures, and any and all directives (such as, but not limited to, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regards to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment). The Company may adopt, vary or rescind these policies and directives in its absolute discretion and without any limitation (implied or otherwise) on its ability to do so
  
  

• Life Science Graduates or Allied Medicine Graduates with certification from AAPC or AHIMA
• Sound knowledge in Medical Terminology, Human Anatomy & Physiology
• Proficient in ICD-10-CM, CPT, and HCPCS guidelines
• Demonstrates knowledge of security of systems and associated policies and procedures for maintaining the security of the data contained within the systems
• Proven ability to implement all the updates of AMA guidelines, AHA guidelines, and CMS guidelines
• Proven ability to check NCCI edits and LCD & NCD coverage determinations and modify ICD-10-CM codes, CPT codes, and modifiers accordingly