Senior Recovery / Resolution Analyst - National Remote

  • UnitedHealth Group
  • Hartford, CT, United States
Full Time

Job Description

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

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 doing your life’s best work.SM

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.

This position is full-time (40 hours/week) Monday - Friday. Employees are required to work our normal business hours of 8:00am – 5:00pm in residing time zone. It may be necessary, given the business need, to work occasional overtime or weekends. Training will be conducted virtually from your home.

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

Primary Responsibilities:

  • Examine, assess, and document business operations and procedures to ensure data integrity, data security and process optimization.
  • Investigate, recover, and resolve all types of claims as well as recovery and resolution for health plans, commercial customers, and government entities
  • 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
  • Use pertinent data and facts to identify and solve a range of problems within area of expertise

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.

Required Qualifications:

  • High School Diploma / GED (or higher)
  • 2+years auditing professional claims to required
  • 2+ years practical specialty coding experience (Neurology, Cardiology, Orthopedics, etc.)
  • 2+ years of practical experience interpreting reimbursement policies and provisions for Medicare, Community and State, Employer and Individual
  • 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)
  • Certified Coder AHIMA or AAPC Certified coder (CPC, CCS, CCA, RHIT, CPMA, RHIA, CDIP) OR Nurse (RN, LPN) unrestricted nurse certified coder with AHIM or AAPC
  • Understanding of Waste & Error principles
  • Proficient in Microsoft Excel
  • Strong medical record review experience
  • Knowledge of health insurance business, industry terminology, and regulatory guidelines

Preferred Qualifications:

  • Bachelor’s Degree (or higher)
  • 2+ years of experience in Quality/Quality Management medical record review
  • 1+ years of experience of UHC platforms – COSMOS, Facets, CIRRUS, UNET, ISET and CPW
  • Experience with Fraud Waste & Abuse or Payment Integrity
  • Investigational and/or auditing experience, including government and state agency auditing
  • Microsoft OneNote (utilize and update information), Microsoft Outlook (ability to send / receive emails and utilize calendar), and Microsoft Teams (able to participate in chats and calls)

Soft Skills:

  • Highly organized with effective communication skills
  • Strong written communication skills
  • Open to change and new information; ability to adapt in changing environments and integrate best practices
  • Strong, analytical, problem-solving, and decision-making skills; ability to exercise good judgment.
  • Time management and prioritization skills
  • Ability to assist with focusing activities on a strategic direction and achieve targets demonstrated data management and/or project management
  • Strong, analytical, problem-solving, and decision-making skills; ability to exercise good judgment.

Telecommuting Requirements:

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

UnitedHealth Group requires all new hires and employees to report their COVID-19 vaccination status.

Military & Veterans find your next mission: We know your background and experience is different and we like that. UnitedHealth Group values the skills, experience and dedication that serving in the military demands. In fact, many of the values defined in the service mirror what the UnitedHealth Group culture holds true: Integrity, Compassion, Relationships, Innovation and Performance. Whether you are looking to transition from active duty to a civilian career, or are an experienced veteran or spouse, we want to help guide your career journey. Learn more at https://uhg.hr/transitioning-military

Learn how Teresa, a Senior Quality Analyst, works with military veterans and ensures they receive the best benefits and experience possible. https://uhg.hr/vet

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care 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, Connecticut or Nevada Residents Only:The salary range for Colorado residents is $26.15 - $46.63. The salary range for Connecticut / Nevada residents is $28.85 - $51.30. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives

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: #RPO, #YELLOW

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