Senior Recovery Resolution Analyst - National Remote

  • UnitedHealth Group
  • Austin, TX, 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

Investigate Optum Waste and Error stopped claims by gathering information, researching state and federal guidelines, and following internal procedure to determine the viability of the claim for further review in a production environment.   

This position is full-time. 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. It may be necessary, given the business need, to work occasional overtime.

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

Primary Responsibilities:

  • Clinical Case Reviews
  • Perform clinical review of professional (or facility) claims vs. medical records to determine if the claim is supported or unsupported. 
  • Maintain standards for productivity and accuracy.  Standards are defined by the department. 
  • Provide clear and concise clinical logic to the providers when necessary. 
  • Other internal customer correspondence and team needs
  • Attend and provide feedback during monthly meetings with assigned internal customer department. 
  • Provide continuous feedback on how to improve the department relationships with internal team members and departments. 
  • Continue education
  • Keep up required Coding Certificate and/or Nursing Licensure. 
  • Complete compliance hours as required by the department. 

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 of medical record coding experience
  • Working knowledge of medical terminology and/or claim coding. 
  • Proficiency with personal computers, including Microsoft Suite of products.  
  • Coding Certificate, (Certified Professional Coder (CPC), Certified Inpatient Coder (CIC), Certified Outpatient Auditor (COC), Certified Professional Medical Auditor (CPMA), or Certified Coding Specialist (CCS), RHIA, RHIT, CCSP
  • Ability to work full-time between 8:00am – 5:00pm including the flexibility to work occasional overtime given the business need

Preferred Qualifications:  

  • Previous presentation or policy documentation experience
  • Experience in Evaluation and Management Services in the outpatient/office setting. 
  • Working knowledge of the healthcare insurance managed care industry. 
  • Previous experience in claim processing, healthcare provider information and healthcare billing practices 

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

Soft Skills:  

  • Strong written and verbal communications skills.
  • Ability to work in a team. 
  • Strong customer service skills. 
  • Strong analytical and problem-solving skills. 

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 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 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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