1+ months

Senior Recovery Resolution Analyst - US Remote

Minneapolis, MN 55415 Work Remotely
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  • Job Code
    885252

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

The Senior Recovery Resolution Analyst will Investigate Optum Waste and Error Claims Reviews to ensure accuracy of medical coding & billing.


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


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


Primary Responsibilities:

  • Performs clinical coverage review of CPT and HCPCS coded claims in a telecommuting work environment determining payment recommendation
  • Determines appropriate level of service utilizing Evaluation and Management Coding principles
  • Ensures adherence to state and federal compliance policies, reimbursement policies and contract compliance
  • Responsible for Clinical and Coding expertise in the application of medical and reimbursement policies within the claim adjudication process through file review. 
    • This could include Medical Director/physician consultations, interpretation of state and federal mandates, applicable benefit language, medical and reimbursement policies and consideration of relevant clinical information
  • Performs clinical coverage review of post-service, pre-payment claims, which requires interpretation of state and federal mandates, applicable benefit language, medical & reimbursement policies, coding requirements and consideration of relevant clinical information on claims with aberrant billing patterns
  • Performs clinical coding review to ensure accuracy of medical coding and utilizes clinical expertise and judgment to determine correct coding & billing
  • Identifies aberrant billing patterns and trends, evidence of fraud, waste or abuse, and recommends providers to be flagged for review
  • Maintains and manages daily case review assignments, with accountability to quality and productivity standards
  • Provides clinical support and expertise to the other investigative and analytical areas
  • Participates in team and network meetings, engaging in a collaborative work environment
  • Serves as a clinical resource to other areas within the clinical investigative team

You'll 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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Posted: 2020-09-08 Expires: 2020-11-23

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 Recovery Resolution Analyst - US Remote

UnitedHealth Group
Minneapolis, MN 55415

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