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  • Phoenix, AZ

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Senior Claims Recovery / Resolutions Analyst – US Telecommute

UnitedHealth Group • Phoenix, AZ

Posted 10 days ago

Job Snapshot

Healthcare - Health Services
General Business, Health Care


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Job Description

enjoy the flexibility to telecommute* from anywhere within the U.S. as you take
on some tough challenges.  The
health care system is still evolving at a rapid pace. Technology is driving new
advances in how patient care is delivered and how it’s reimbursed. Now, UnitedHealth
invites you to help us build a more accurate and precise approach to
claims adjudication.

*All Telecommuters will be required to adhere to UnitedHealth
Group’s Telecommuter Policy.

The Claims Recovery Services Team is responsible for identifying waste and
error in billing practices from medical offices, clinics and hospitals with the
end goal to reduce overall medical costs. As a member of this team, you will be
reviewing and auditing submitted by the providers to determine accuracy,
correct coding, etc. You’ll have all the tools and backing you need to help
manage and ensure adherence to compliance policies. All the while, you’ll be
building your career with a leader and reaching for the highest levels of
performance as you do your life's best work.SM

Primary Responsibilities

  • Investigates, reviews, and provides clinical and/or
    coding expertise in review of post-service, pre-payment or post payment claims,
    which requires interpretation of state and federal mandates, billing
    practices/patterns, applicable benefit language, medical and reimbursement
    policies, coding requirements and consideration of relevant clinical
    information on claims with overt billing patterns and make pay/deny or payment
    recommendation decisions based on findings. This could include Medical Director/ physician consultations and working
    independently while making their decisions.
  • Identifies overt billing trends, waste and error
    identification, and recommends providers to be flagged or filtered for review
    and works with analytics on recommendations to increase line of business
    savings by client.
  • Identifies updated clinical analytics opportunities and
    participates in projects necessary by client/other departments
  • Maintains and manages daily case review assignments, with
    a high emphasis on quality, with at least 98% accuracy and within client/CMS
    guidelines and provides clinical explanation both to the provider
  • Participates in provider/client/network meetings, which
    may include provider education through written communication and participates
    in additional projects as needed.
  • Participates in training of new staff and serves as a
    clinical resource to other areas within the clinical investigative team and
    provides guidance and feedback to peers when applicable.

This is a challenging role with serious impact. You’ll need to sort through
complex situations to understand and clarify where errors happened or where
they may continue to happen. It’s a fast paced environment that takes focus,
intensity and resilience.

Required Qualifications

  • Certified coder AHIMA or AAPC Certified coder (CPC, CCS,
    CCA, RHIT, CPMA, RHIA, CDIP) or Nurse (RN, LPN) with unrestricted and active
  • Undergraduate degree or equivalent experience
  • 2+ years of CPT/HCPCS coding experience on a healthcare
    claims/processing team
  • Proficiency with computer and Windows PC applications
    including ability to navigate and learn new and complex computer system
    applications and troubleshoot problems

Preferred Qualifications

  • Investigational and/or auditing experience, including
    government and state agency auditing
  • 1+ year experience with UHG platforms - COSMOS, Facets
    and CPW and/or working with medical terminology or coding
  • Strong communication skills with the ability to interpret
  • Experience with Fraud Waste & Abuse or Payment
  • Strong analytical mindset 

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.SM

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Key words:  Healthcare, health care, Managed
Care, Claims, Customer Service, Claims Recovery, Telecommute, call center, Work
from Home, Remote, coding

Job ID: 2551_782105_1
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