Senior Recovery / Resolution Analyst - US Telecommute

Description: Energize your career with one of Healthcare s fastest growing companies.

You dream of a great career with a great company - where you can make an impact and help people.

We dream of giving you the opportunity to do just this.

And with the incredible growth of our business, it s a dream that definitely can come true.

Already one of the world s leading Healthcare companies, UnitedHealth Group is restlessly pursuing new ways to operate our service centers, improve our service levels and help people lead healthier lives.

We live for the opportunity to make a difference and right now, we are living it up.

This opportunity is with one of our most exciting business areas: Optum - a growing part of our family of companies that make UnitedHealth Group a Fortune 17 leader.

Optum helps nearly 60 million Americans live their lives to the fullest by educating them about their symptoms, conditions and treatments; helping them to navigate the system, finance their healthcare needs and stay on track with their health goals.

No other business touches so many lives in such a positive way.

And we do it all with every action focused on our shared values of Integrity, Compassion, Relationships, Innovation & Performance.

The Senior Recovery / Resolution Analyst will 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.

Positions in this function are responsible for investigating, reviewing, and resolving professional and / or facility provider claims on behalf of our commercial and government customers and their health plans.

This may include participation in telephone calls or meetings with providers, clients and other investigative areas.

Ensure adherence to state and federal compliance policies, reimbursement policies and contract compliance.

Primary Investigates, reviews, and provides clinical and / or 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 and reimbursement policies, coding and consideration of relevant clinical information on claims with over billing patterns.

Performs clinical coding review to ensure accuracy of medical coding and utilizes clinical expertise and judgment to determine correct coding and billing.

Identifies over billing patterns and trends, waste and error, and recommends providers to be flagged for review.

Maintains and manages daily case review assignments, with a high emphasis on quality.

Provides clinical support and expertise to the other investigative and analytical areas.

Participates in provider / client / network meetings, which may include provider education through written communication.

Participates in training of new staff, and serves as a clinical resource to other areas within the clinical investigative team.

Required High School Diploma / GED (or higher) 2+ years of experience as a Certified Coder AHIMA or AAPC Certified, CPC, CCS, RHIT, CPMA, RHIA with 2+ years of CPT / HCPCS coding experience with knowledge of health insurance business, including knowledge of industry terminology, and regulatory guidelines, or 2+ years of RN, LPN current experience with an unrestricted license with 2+ years of CPT / HCPCS coding experience with knowledge of health insurance business, including knowledge of industry terminology, and regulatory guidelines.

Certified Coder AHIMA or AAPC Certified, CPC, CCS, RHIT, CPMA, RHIA or RN, LPN with unrestricted license.

Preferred Bachelor s Degree (or higher).

Healthcare Claims experience.

Investigational and / or Auditing experience.

Knowledge of claims processing system.

Knowledge of CMS 1500 claim form.

Soft Skills: Analytic problem solving skills .

Physical and Work Environment: Frequent speaking, listening, using a headset, sitting, use of hands / fingers across keyboard and use of mouse, and working at a computer.

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.

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.

Keywords: RN, LPN unrestricted license; Certified Coder AHIMA or AAPC Certified, CPC, CCS, RHIT, CPMA, RHIA; CPT / HCPCS coding; healthcare claims; Optum; UnitedHealth Group; UHG; UnitedHealthcare; UHC