Senior Research Analyst

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.

Function as expert in Interventional Radiology and CPT coding Function as CPT subject matter expert (SME) liaison between product, marketing, sales, and SME staff Function as a coding, billing, reimbursement, and regulatory policy SME for Optum Referential Content Team Apply US Billing and Coding expertise in current coding systems (ICD-10-CM/ CPT/HCPCS) and operational expertise to provide up-to-date, clear and concise content for all products Maintain official sources for defensible support for product content Respond to CPT/HCPCS and Medicare questions/queries for internal and external customers Provide Director, SME team members, Product Managers, Sales, and Marketing with information on healthcare industry changes that impact the business Responsible for specific services, functions, and solutions available internally or as a supporting element of a product, typically not sold stand-alone externally. Positions in this function play a critical role in ability to deliver products to market and/or manage internal business functions. Capability management requires alignment to business and/or product strategy, effective design and development, and ongoing management of capability portfolio across the full lifecycle to ensure business-specific or cross-enterprise impact. Market insights are leveraged to monitor trends and external landscape, and to inform capability strategies and customer use case scenarios. Positions in this function are accountable for delivering sustainable, financially sound solutions that solve a specific problem and enable successful external product delivery and/or internal business function performance, while driving adoption with internal business clients and define future capability direction that supports business strategy and new opportunities 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 Required Qualifications: Graduate degree or equivalent professional experience Certified Outpatient Coder (COC) or equivalent outpatient coding certification Certified Professional Medical Auditor (CPMA) 5+ years of outpatient Interventional Radiology (IR) U.S. medical coding experience Experience in denial management and appeals review, including identification and resolution of coding-related denials Experience in creating, implementing, and maintaining rules within claim scrubbing/editing tools to improve claim quality and reimbursement outcomes Experience in AI implementation, including leveraging artificial intelligence solutions to improve coding, auditing, compliance, operational efficiency, or revenue cycle processes Solid knowledge of U.S. outpatient coding regulations, reimbursement methodologies, and compliance requirements Proven excellent analytical, auditing, and problem-solving skills with the ability to interpret complex coding scenarios and