Identify appropriate assignment of CPT and ICD 10 Codes for outpatient Emergency Room Department services while adhering to the official coding guidelines and established client coding guidelines of the assigned facility Expert knowledge in ProFee coding specialties; Evaluation & Management, Emergency Room Apply coding knowledge to analyze/correct CCI Edits and Medical Ne

Identify appropriate assignment of CPT and ICD 10 Codes for outpatient ancillary services while adhering to the official coding guidelines and established client coding guidelines of the assigned facility Apply coding knowledge to analyze/correct CCI Edits and Medical Necessity Edits Understand the Medicare Ambulatory Payment Classification (APC) codes Abstract additional

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

Serve as a member of the operations senior leadership team and advise executives on external trends, problems, and activities to facilitate both short and long range strategic plans to improve operational performance and enhance growth. Set the vision and strategic plan for OptumRx PBM operations & client services and support scaled operations through solid partnership ac

Complete provider orders per state and provider regulations Perform Clinical Intake with patients to include taking and recording vital signs and patient history Assist patients as needed with walking, transfer, specimen collection, exam preparation, etc. Complete occupational health testing including such services as urine drug screens, breath alcohol testing, hair testi

Leadership responsibilities Manage all aspects of the P&L, including driving growth, reducing medical expense, STARs performance, coding accuracy and administrative cost efficiency Lead the strategy creation and implementation, spanning assets in the benefit and care delivery space Organize the current businesses into a cohesive unit to deliver best in class integrated me

Follow established departmental policies, procedures and objectives Notify Provider Enrollment Manager of non compliance issues May involve travel to meet with providers to ensure complete and accurate forms are completed Completion of PIN form for submission to Excellian, track payer data in Symed Follow up on outstanding enrollment issues to ensure timely reimbursement

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

Conduct solution focused consultations; helping clients define goals, plan action and gain insight Assess and refer to appropriate programs and services including but not limited to Worklife, behavioral health, substance abuse / chemical dependency and community based resources Assist with referrals for members needing ongoing/additional counseling services Provide limite

Establish and maintain positive clinical rapport with patients and their families, working closely with them in the provision of infusion therapy, education related to self care and self administration, and clinical monitoring of patient response to therapy Assess patient appropriateness for home infusion therapy, including safety of the home environment, availability of

Lead a high performing, multi disciplinary global engineering team of 700+ engineers across web, mobile and portal solutions Define the digital technology strategy for end to end omni channel digital experiences Formulate and lead both near term and long term digital product development strategies and ongoing deliveries Create high performing product model across all disc

Perform research which advances the state of the art in AI and ML Implement algorithms and evaluate their performance on healthcare data Communicate results across an interdisciplinary team and explore use cases which improve real world healthcare outcomes Document research internally and externally, including publications in machine learning and other scientific conferen

This role will provide coding quality auditing services to ensure compliance with Optum and CMS coding guidelines and accuracy of coding data reported. Must 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

IT Pillar financial responsibilities spanning across multiple long term MPP clients totaling billions of dollars in TCV Scaling financial operations related to IT Delivery across MPP clients Monitoring of financial spend in comparison to contract to ensure that no financial leakage occurs Work with operational leaders to monitor financial performance compared to deal pro

Perform financial clearance processes by interviewing patients and collecting and recording all necessary information for pre registration of patients Educate patients of pertinent policies as necessary i.e., Patient Rights, HIPAA information, consents for treatment, visiting hours, etc Verify insurance eligibility and completes automated insurance eligibility verificatio