Senior Recovery Resolution Analyst - National Remote
Company: UnitedHealth Group
Posted on: November 25, 2022
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.
- Confidently analyze and interpret data and medical
records/documentation daily to understand historical claims
activity, determine validity and demonstrate their ability to
provide written communication to the provider. -
- Be responsible to investigate, review and provide clinical
and/or coding expertise in a review of pre-payment claims.
- 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. -
- Proficient in computer skills and able to navigate multiple
systems at one time with varying levels of complexity.
- Could research and work independently on making decisions on
complex cases. - -
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 of8:00am 4:30pm. 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:
- Performs quality audits of clinical review cases of CPT, HCPCS,
and modifiers assigned to codes on claims in a telecommuting work
- 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
- Maintains and manages daily case review assignments, with
accountability to quality, utilization, and productivity
- 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
- High School Diploma / GED (or higher)
- 1+ years of working in a team atmosphere in a metric driven
environment including daily production standards and quality
- 2+ years of experience as an AHIMA or AAPC Certified coder with
2+ years of CPT/HCPCS/ICD - 10/CM/PCS coding experience or Licensed
nurse with medical record auditing and coding/billing
- Medical record review experience
- Knowledge of health insurance business, industry terminology,
and regulatory guidelines.
- Basic to intermediate experience with Microsoft & Adobe
applications (outlook, power point, word, excel, pdf).
- Experience must include CPT/HCPCS/Modifiers (Medical necessity
and DRG review experience is not applicable to this position).
- 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 with medical record auditing and
- Bachelor's Degree (or higher)
- Healthcare claims experience/processing experience.
- Experience with Fraud Waste & Abuse or Payment Integrity.
- Strong communication skills with the ability to interpret
- Experience with subsequent or reconsideration reviews for
- Strong analytical mindset working with medical terminology or
- Ability to keep all company sensitive documents secure (if
- Required to have a dedicated work area established that is
separated from other living areas and provides information
- Must live in a location that can receive a UnitedHealth Group
approved high-speed internet connection or leverage an existing
high-speed internet service
- Computer skills with the ability to troubleshoot problems.
- Proficient and able to navigate and maneuver multiple systems
at one time with varying levels of complexity.
Physical Requirements and Work Environment:
- Frequent speaking, listening using headset, sitting, use of
hands/fingers across keyboard.
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 to $46.63. The salary range for Connecticut /
Nevada residents is $28.85 to $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. #RPO #YELLOW
Keywords: UnitedHealth Group, Plano , Senior Recovery Resolution Analyst - National Remote, Professions , Plano, Texas
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