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We have modest goals: Improve the lives of others. Change the landscape of health care forever. Leave the world a better place than we found it. Such aspirations tend to attract a certain type of person. Crazy talented. Compassionate. Driven. To these individuals, we offer the global reach, resources and can-do culture of a Fortune 5 company. We provide an environment where you’re empowered to be your best. We encourage you to take risks and in return, offer a world of rewards and benefits for performance. Exceeding your limits is an exceptional start to your life's best work.SM

 

Just like you, we are driven by a set of fundamental principles that are guiding our way forward. Our values of integrity, compassion, relationships, innovation, and performance serve as a foundation to transform health care. Are you in? Learn more about your future at UnitedHealth Group at careers.unitedhealthgroup.com

 

Job Category:

Claims

Country:

US

Approximate Salary:

Not Specified

Position Type:

Full Time

Senior Conditional Payment Analyst - Tampa, FL

UHG - Tampa, Florida

Posted: 11/12/2018

Welcome to one of the toughest and most fulfilling ways to help people, including yourself. We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement. Join us and start doing your life's best work.


Responsible for all aspects of assigned cases for analyzing and appeal / dispute process of conditional payments.

Primary Responsibilities: 

Responsible for all conditional payment analyzing for Medicare, Medicare Advantage Plans and Medicaid for workers’ compensation, auto and liability cases.Responsible for all appeals and disputes on conditional payments when requested by client.Serve as the liaison between Optum Settlement Solutions and BCRC / CRC / CMS  / MAPs / Medicaid.Performs follow up for final settlement documents and distributes to the lead contractor once received.Works directly with legal staff for final demands or appeals process.Processes all mail related to appeals and disputes from the BCRC / CRC.Manages the required paperwork such as Letters of Authorization, Proof of Representation and Consent to Release forms.Works directly in the Medicare Secondary Payer Recovery portal (internet - based) and Optum’s MedicareConnect portal.Distributes the status responses that the BCRC / CRC generates.Provides status updates to client regarding conditional payment issues.Responsible for handling all phone calls, emails and faxes on assigned cases. Participates on client conference calls and trains new associates within the conditional payment team, as needed.Works with Management on special projects as necessary.Performs other job functions as assigned by management.

Required Qualifications:

  • High School Diploma / GED or higher  
  • 3+ years of complex Claims experience (i.e. Worker’s Compensation / Auto / Liability, Case Management, High Dollar Claims, Medicare Secondary Payor Services)
  • Ability to create and edit professional documents in Microsoft Word
  • Ability to create and edit spreadsheets in Microsoft Excel
  • Ability to use Outlook to send and create emails 
  • Knowledge of / work experience utilizing ICD9 / ICD10 coding
  • Medical terminology understanding

Preferred Qualifications:

  • Associate's Degree or higher
  • Medical, Paralegal, Adjuster background or prior Conditional Payment Negotiation experience
  • Previous Medicare Secondary Payer Recovery experience
  • Previous Medical Claims Appeals experience

Soft Skills:

  • Ability to work in a fast paced environment
  • Ability to manage one's own time and work with a team
  • Must have strong organizational skills, detail oriented and focus on meeting deadlines
  • Strong written and verbal communication skills
  • Ability to analyze legal and medical documentation to assist with formulating dispute and appeal letters

Physical Requirements and Work Environment:

  • Extended periods of sitting at a computer and use of hands / fingers across keyboard or mouse
  • Office environment

OptumRx is an empowering place for people with the flexibility to help create change. Innovation is part of the job description. And passion for improving the lives of our customers is a motivating factor in everything we do.

 

If you're ready to talk about groundbreaking interactions, let's talk about what happens when a firm that touches millions of lives decides to gather results from millions of prescriptions every month and analyze their impact. Let's talk about smart, motivated teams. Let's talk about more effective and affordable healthcare solutions. This is caring. This is great chemistry. This is the way to make a difference. We're doing all this, and more, through a greater dedication to our shared values of integrity, compassion, relationships, innovation and performance.  Join us and start doing your life’s best work.SM


Diversity creates a healthier atmosphere: United Health 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.


United Health Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.


Keywords: United Health Group, United Health Care, Claims, Processing, Customer Service, Analyst, Audit, Pharmacy, Medical

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