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 is required to determine the accuracy of claims submitted by a provider to UNITEDHEALTH GROUP by comparing it to the medical record(s) submitted for the date(s) of service being reviewed. They must be able to exercise judgement/decision making on complex payment decisions that directly impacts the provider and UHC/Client by following state and government compliance guidelines, coding requirements and policies. They must confidently analyze and interpret data and medical records/documentation on a daily basis to understand historical claims activity, determine validity and demonstrate their ability to provide written communication to the provider.  They are responsible to investigate, review and provide clinical and/or coding expertise in a review of pre-payment claims. They need to effectively manage their caseload and monthly metrics in a production driven environment and ensure they are meeting all compliance turnaround times mandated by the client. The Senior Recovery Resolution Analyst must be proficient in computer skills and able to navigate multiple systems at one time with varying levels of complexity. They must have the ability to research and work independently on making decisions on complex cases.  

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 – 4:30pm CST. It may be necessary, given the business need, to work occasional overtime. TRAINING WILL BE CONDUCTED VIRTUALLY FROM YOUR HOME.

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

PRIMARY RESPONSIBILITIES:

• Performs clinical review of CPT, HCPCS, and modifiers assigned to codes on claims in a telecommuting work environment.

• Determines accuracy of medical coding/billing and payment recommendation for pre-payment claims.

  • 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.

• Determines appropriate level of service utilizing Evaluation and Management coding principles.

• Ensures adherence to state and federal compliance policies, reimbursement policies and contract compliance.

• 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, utilization and productivity standards.

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

• Participates in team and department meetings.

• Engages in a collaborative work environment when applicable but is also able to work independently.

• Serves as a clinical resource to other areas within the clinical investigative team.

• Work with applicable business partners to obtain additional information relevant to the clinical review.

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)

• Certified Coder AHIMA or AAPC Certified coder (CPC, CCS, CCS-P, RHIT, CPMA, RHIA, CDIP) or Nurse (RN, LPN) with unrestricted and active license/certification

• 2+ years of experience as a AHIMA or AAPC Certified coder with 2+ years of CPT/HCPCS/ICD – 10/CM/PCS coding experience or Licensed nurse

  • Experience must include CPT/HCPCS/Modifiers (Medical necessity and DRG review experience is not applicable to this position).

• 1+ years of working in a team atmosphere in a metric driven environment including daily production standards and quality standards.  

• Medical record review/audit experience.

• Knowledge of health insurance business, industry terminology, and regulatory guidelines.

• Must have strong computer skills with the ability to troubleshoot problems.  

• Basic to Intermediate experience with Microsoft Word, Excel, PowerPoint, Outlook and Adobe (ability to create, edit, save and send documents, spreadsheets, presentations, correspondence and pdf files)

PREFERRED QUALIFICATIONS:

• Bachelor’s degree (or higher).
• Healthcare claims experience/processing experience
• Experience with Fraud Waste & Abuse or Payment Integrity.

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 analytical mindset working with medical terminology or coding.
• Strong communication skills with the ability to interpret data.
• Must be proficient and able to navigate and maneuver multiple systems at one time with varying levels of complexity.

PHYSICAL AND WORK ENVIRONMENT:

• Frequent speaking, listening using headset, sitting, use of hands/fingers across keyboard.

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 Residents Only: The hourly range for Colorado residents is $25.63 to $45.72. 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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