11 days old

Retrospective Clinical Investigator - Remote - 928455

Dallas, TX 75201 Work Remotely
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  • Job Code
    928455

Welcome to one of the toughest and most fulfilling ways to help people, including yourself. We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement. Join us and start doing your life's best work.SM

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The Retrospective Clinical Investigatorwill work with a team on researching issues to determine feasibility of reducing medical costs through prospective solutions of claim system processes and claim business rules.

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This position is full-time (40 hours/week) Monday - Friday. Employees are required to work our normal business hours of 8:00am 5:00pm. It may be necessary, given the business need, to work occasional overtime or weekends.

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Youll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

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*All Telecommuters will be required to adhere to UnitedHealth Groups Telecommuter Policy.

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Primary Responsibilities:

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  • Examine, assess, and document business operations and procedures to ensure data integrity, data security and process optimization.
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  • Investigate, recover, and resolve all types of claims as well as recovery and resolution for health plans, commercial customers, and government entities
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  • Investigate and pursue recoveries and payables on subrogation claims and file management
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  • Initiate phone calls to members, providers, and other insurance companies to gather coordination of benefits information
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  • Process recovery on claims
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  • Ensure adherence to state and federal compliance policies, reimbursement policies, and contract compliance
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  • Use pertinent data and facts to identify and solve a range of problems within area of expertise
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Youll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

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Required Qualifications:

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  • High school diploma or GED (or higher)
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  • Certified Coder AHIMA or AAPC Certified coder (CPC, CCS, CCA, RHIT, CPMA, RHIA, CDIP) or Nurse (RN, LPN) with unrestricted license
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  • 2+ years of experience as AHIMA or AAPC Certified coder (CPT/HCPCS/ICD 10/CM/PCS coding experience) or Licensed nurse with 2+ years of CPT/HCPCS/ICD 10/CM/PCS coding experience (Professional)
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  • 2+ years ofpractical specialty coding (Neurology, Cardiology, Orthopaedics, etc.)
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  • 2+ yearsof practical experience interpreting reimbursement policies and provisions for Medicare, Community and State, Employer and Individual
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  • Proficient in Excel (vlookups, pivot tables, etc.)
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  • Strong medical record review experience
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  • Knowledge of health insurance business, industry terminology, and regulatory guidelines
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  • If you need to enter a work site for any reason, you will be required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or a similar UnitedHealth Group - approved symptom screener. When in a UnitedHealth Group building, employees are required to wear a mask in common areas. In addition, employees must comply with any state and local masking orders
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Telecommute Requirements:

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  • Required to have a dedicated work area established that is separated from other living areas and provides information privacy
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  • Ability to keep all company sensitive documents secure (if applicable)
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  • Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service
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Preferred Qualifications:

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  • Bachelors degree (or higher)
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  • 2+ years ofauditing professional claims experience
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  • 2+ years of experience in Quality/Quality Management medical record review
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  • 1+ year of experience of UHC platforms COSMOS, Facets, CIRRUS, UNET, ISET and CPW
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  • Investigational and/or auditing experience, including government and state agency auditing
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  • Experience with Fraud Waste & Abuse or Payment Integrity.
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  • Experience in training, mentoring and/or development with adult learners
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  • Ability to assist with focusing activities toward a strategic direction and achieve targets demonstrated data management and/or project management skills
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  • An understanding of Waste & Error principles
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  • Knowledge of Medicare reimbursement methodologies, i.e. Resource Based Relative Value System (RBRVS)
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  • Microsoft Teams (able to participate in chats and calls)
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  • Microsoft OneNote (utilize and update information)
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  • Microsoft Outlook (ability to send / receive emails and utilize calendar)
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Soft Skills:

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  • Highly organized with effective and persuasive communication skills
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  • Strong written communication skills
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  • Open to change and new information; ability to adapt in changing environments and integrate best practices
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  • Strong, analytical, problem-solving and decision-making skills; ability to exercise good judgment.
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  • Time management and prioritization skills
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UnitedHealth Group is an essential business.The health and safety of our team members is our highest priority, so we are taking a science driven approach to slowly welcome and transition some of our workforce back to the office with many safety protocols in place. We continue to monitor and assess before we confirm the return of each wave, paying specific attention to geography-specific trends. At this time, 90% of our non - clinical workforce transitioned to a work at home (remote) status. We have taken steps to ensure the safety of our 325,000 team members and their families, providing them with resources and support as they continue to serve the members, patients and customers who depend on us.

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You can learn more about all we are doing to fight COVID-19 and support impacted communities at:https://www.unitedhealthgroup.com/newsroom/addressing-covid.html

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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 doyour life's best work.SM

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Colorado Residents Only: The salary/hourly range for Colorado residents is $25.63 to 45.72. Pay is based on several factors including but not limited to education, work experience, certifications, etc. As of the date of this posting, In addition to your salary, UHG offers the following benefits for this position, subject to applicable eligibility requirements: Health, dental, and vision plans; wellness program; flexible spending accounts; paid parking or public transportation costs; 401(k) retirement plan; employee stock purchase plan; life insurance, short-term disability insurance, and long-term disability insurance; business travel accident insurance; Employee Assistance Program; PTO; and employee-paid critical illness and accident insurance.

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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.

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

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Keywords: claims, data entry, coding, medical coding, customer service representative, customer service, CSR, UnitedHealth Group, Optum, OptumRx, call center, UnitedHealthcare, health care, healthcare, office, phone support, training class, advocate, work at home, work from home, WAH, WFH, remote, telecommute, hiring immediately, #rpo

Posted: 2021-06-03 Expires: 2021-07-10

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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Retrospective Clinical Investigator - Remote - 928455

UnitedHealth Group
Dallas, TX 75201

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