SME - Home Health Coding

Job Description As a member of the team at Optum, you will play a crucial role in improving health outcomes worldwide by connecting individuals with the necessary care, pharmacy benefits, data, and resources to enhance their well-being. You will be part of a culture that values inclusion, offers career development opportunities, and provides comprehensive benefits. Your contributions will help advance health optimization on a global scale, making a positive impact on the communities we serve. **Key Responsibilities:** - Your key performance indicators (KPIs) will include but are not limited to Productivity, quality, TAT, Attendance, and Attrition. - Utilize logical data understanding for quick turnaround. - Manage personnel, performance, and discipline of assigned project(s). - Offer expertise and leadership in your assigned functional area. - Handle client interactions and communications, taking the lead in client relationships. - Review and analyze periodic reports and metrics. - Evaluate operational practices and procedures for process improvements. - Support quality initiatives and ensure compliance parameters are met. - Foster a positive working environment promoting morale, quality, creativity, and teamwork. - Provide guidance to staff, resolve issues, and set priorities. - Assist senior management in planning, implementing, and evaluating operations, systems, and procedures. - Develop retention strategies and manage attrition. - Prepare annual business plans, including operating budgets. - Negotiate solutions, resolve conflicts, and handle critical situations. - Offer regular performance feedback and coaching sessions. **Required Qualifications:** - 4+ years of experience. - Possess any medical coding certification (CPC, CCS, etc); BCHHC. - Understanding of PDGM (Patient-Driven Groupings Model), including primary diagnosis selection and comorbidity adjustments. - Demonstrated skill in identifying missing, conflicting, or insufficient documentation. - Ability to perform provider queries as necessary. - Strong analytical thinking and problem-solving skills. - Training and mentoring capability, especially for SME roles. - Proficiency in ICD10CM guidelines (Chapters 1-21) and application of etiology/manifestation coding rules. - Expertise in coding various conditions such as diabetes, wounds, fractures, CVA late effects, COPD, CHF, etc. At UnitedHealth Group, the mission is to help individuals lead healthier lives and improve the health system for all. The commitment to enabling equitable care, addressing health disparities, and enhancing health outcomes is a top priority reflected in the company's mission. As a member of the team at Optum, you will play a crucial role in improving health outcomes worldwide by connecting individuals with the necessary care, pharmacy benefits, data, and resources to enhance their well-being. You will be part of a culture that values inclusion, offers career development opportunities, and provides comprehensive benefits. Your contributions will help advance health optimization on a global scale, making a positive impact on the communities we serve. **Key Responsibilities:** - Your key performance indicators (KPIs) will include but are not limited to Productivity, quality, TAT, Attendance, and Attrition. - Utilize logical data understanding for quick turnaround. - Manage personnel, performance, and discipline of assigned project(s). - Offer expertise and leadership in your assigned functional area. - Handle client interactions and communications, taking the lead in client relationships. - Review and analyze periodic reports and metrics. - Evaluate operational practices and procedures for process improvements. - Support quality initiatives and ensure compliance parameters are met. - Foster a positive working environment promoting morale, quality, creativity, and teamwork. - Provide guidance to staff, resolve issues, and set priorities. - Assist senior management in planning, implementing, and evaluating operations, systems, and procedures. - Develop retention strategies and manage attrition. - Prepare annual business plans, including operating budgets. - Negotiate solutions, resolve conflicts, and handle critical situations. - Offer regular performance feedback and coaching sessions. **Required Qualifications:** - 4+ years of experience. - Possess any medical coding certification (CPC, CCS, etc); BCHHC. - Understanding of PDGM (Patient-Driven Groupings Model), including primary diagnosis selection and comorbidity adjustments. - Demonstrated skill in identifying missing, conflicting, or insufficient documentation. - Ability to perform provider queries as necessary. - Strong analytical thinking and problem-solving skills. - Training and mentoring capability, especially for SME roles. - Proficiency in ICD10CM guidelines (Chapters 1-21) and application of etiology/manifestation coding rules. - Expertise in coding various conditions such as diabetes, wounds, fractures, CVA l