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 Group invites you to help us build a more accurate and precise approach to claims adjudication. As part of our Recovery and Resolutions team, you’ll provide consultative support to our business units and external vendor organizations. You’ll handle requests, define business requirements and coordinate resolutions incorporating State and Federal regulations. Join us and build your career with an industry leader.
This position is full-time (40 hours/week) Monday - Friday. Employees are required to have flexibility to work any of our 8 hour shift schedules during our normal business hours of (8:00am- 5:00pm). This is a telecommute position.
You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges. Training will be conducted virtually from your home.
*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.
Positions in this function are responsible for investigating, recovering and resolving all types of claims as well as recovery and resolution for health plans, commercial customers and government entities. May include initiating telephone calls to members, providers and other insurance companies to gather coordination of benefits data. Investigate and pursue recoveries and payables on subrogation claims and file management. Process recovery on claims. 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.
- Create and deliver presentation materials to facilitate provider education.
- Lead provider education meetings to drive issue resolution, including potential onsite provider meetings
- Apply principles of adult learning and training best practices to deliver effective and innovative training material.
- Create supporting materials for learning activities (e.g., agendas, schedules, letters, audio/visual aids, etc.)
- Leverage/modify existing training solutions to meet current needs
- Act as a subject matter expert for internal and external partners in the form of assistance with medical coding, documentation requirements based off industry standards.
- Ensures adherence to state and federal mandates for all coding guidance, applicable benefit language, medical & reimbursement policies, coding requirements and consideration of relevant clinical information.
- Discussing the findings as a collaborative team with UHN advocacy, UHC PPS and analyst before approaching the provider call.
- Maintaining positive provider and network relationships.
- Actively owning and resolving issues for Best in Class and / or high-profile providers encountered during education session.
- Analyze data trends prior to education outreach to ensure provider billing errors are addressed in a holistic fashion.
- Responsible for managing individual workload with a high emphasis on quality
This is a challenging role with serious impact. You’ll be assisting, educating, problem-solving and resolving challenging situations to the best possible outcomes. You’ll need to understand and interpret clients’ needs and ensure service and delivery excellence supporting the Fraud, Waste, Abuse, and Error product suite. This involves working with a high complexity solution set and cross functional teams to proactively review, research and resolve highly escalated inquiries.
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.
- High School Diploma / GED (or higher)
- 5+ year experience as a Certified Coder
- 5+ year of experience working in the health insurance business, including knowledge of industry terminology, and regulatory guidelines
- 3+ years providing formal training on medical coding.
- 2+ years of customer service experience
- Proficiency with Microsoft Office such as Word (create and edit documents), PowerPoint (create, edit, and present presentations) and Excel (create, filter/sort, and pivot, spreadsheets)\
- 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 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
- Bachelor’s degree (or higher)
- Training Certification
- CDI Certification
- Managed care experience
- Investigational and/or Auditing experience
- Knowledge of claims platforms
- Experience with FWAE processes and workflow management tools
- Ability to prioritize and manage multiple tasks in an ever-changing environment
- Strong emotional intelligence
- Strong written, verbal, analytical, organizational, time management and problem-solving skills
- Effective interpersonal, influence, collaboration and listening skills for success individually and in a team setting
- Ability to adapt in a dynamic and high-growth environment
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
Your confidence, decisiveness and perseverance will help you positively impact our patient lives. It’s an opportunity to do your life’s best work.SM
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
Colorado Residents Only: The salary range for Colorado residents is $64,800 to $116,000. 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.
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.
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