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Senior Recovery Resolution Analyst - National Remote

Company: UnitedHealth Group
Location: Plano
Posted on: November 25, 2022

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 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 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)
      • 1+ years of working in a team atmosphere in a metric driven environment including daily production standards and quality standards. -
      • 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 experience
      • 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 coding/billing experience
        Preferred Qualifications:
        • 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 data.
        • Experience with subsequent or reconsideration reviews for FWAE
        • Strong analytical mindset working with medical terminology or coding.
          Telecommuting Requirements:
          • Ability to keep all company sensitive documents secure (if applicable)
          • Required to have a dedicated work area established that is separated from other living areas and provides information privacy
          • 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:
            • 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 Learn how Teresa, a Senior Quality Analyst, -works with -military veterans and ensures they receive the best benefits and experience possible. - 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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