26 days old

Senior Medical Claims Recovery / Resolution Analyst - Remote - 937628

Dallas, TX 75201 Work Remotely
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  • Job Code
    937628

Combine two of the fastest - growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making Healthcare data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doingyour lifes best work.SM

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TheSenior Medical Claims Recovery / Resolution Analystwill 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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Positions in this function are responsible for investigating all types of claims for health plans and commercial customers. Ensure adherence to state and federal compliance policies, reimbursement policies and contract compliance. May conduct contestable investigations to review medical history. May monitor large claims including transplant cases.

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  • Generally, work is self-directed and not prescribed
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  • Works with less structured, more complex issues
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  • Serves as a resource to others
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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. 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 and resolve all types of claims as well as recovery and resolution for health plans and commercial customers
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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 / GED (or higher)
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  • Active Coding Certification (any of the following: CPC, CPC-H, CPC-P, CCA, CCS, CCS-P, RHIT, or RHIA), or an RN/LPN with an active license
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  • 2+ years of professional provider based medical coding experience
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  • 1+ years of experience analyzing data and identify cost saving opportunities
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  • Knowledge of claims processing systems and guidelines/reimbursement policies
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  • Intermediate skills with multiple Microsoft applications including Microsoft Excel (ability to create, save, and send spreadsheets), Microsoft Word (ability to create, save, and send documents), Microsoft OneNote (ability to create, manage and update worksheets and tabs), etc.
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  • If you need to enter a work site for any reason, you will berequiredto 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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Preferred Qualifications:

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  • 2+ years of experience with claims auditing and researching claims information
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  • Experience working with medical claims platforms
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  • Intermediate skills with multiple Microsoft applications includingMicrosoft OneNote (ability to create, manage and update worksheets and tabs)
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Telecommuting 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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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. 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 OptumInsight.Information and technology have amazing power to transform the Healthcare industry and improve people's lives. This is where it's happening. This is where you'll help solve the problems that have never been solved. We're freeing information so it can be used safely and securely wherever it's needed. We're creating the very best ideas that can most easily be put into action to help our clients improve the quality of care and lower costs for millions. This is where the best and the brightest work together to make positive change a reality. This is the place to doyour lifes best work.SM

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Colorado Residents Only: The 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: CPC, CPC-H, CPC-P, CCA, CCS, CCS-P, RHIT, RHIA, claims, Cosmos, CPT, ICD-9, coding, nurse, medical records, Optum, United HealthCare, work at home, work from home, WAH, WFH, remote, telecommute, hiring immediately, healthcare claims, medical claims, #rpo

Posted: 2021-06-29 Expires: 2021-07-29

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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Senior Medical Claims Recovery / Resolution Analyst - Remote - 937628

UnitedHealth Group
Dallas, TX 75201

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