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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 Recovery / Resolution Analyst - Eden Prairie, MN or Telecommute

UHG - Eden Prairie, Minnesota

Posted: 12/13/2018

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.(sm)


The Senior Recovery/Resolution Analyst will work with a team on researching issues to determine feasibility of reducing medical costs through prospective solutions of claim system processes and claim business rules.

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.  
 

Primary Responsibilities:

  • Clinical Inventory Management-75%
    • Review medical records to determine if the claim is supported or unsupported
    • Provide clear and concise clinical logic to the providers when necessary
  • Other internal customer correspondence and team needs  – 15%
    • 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 – 10%
    • Keep up required Coding Certificate and/or Nursing Licensure
    • Complete compliance hours as required by the department


 


Required Qualifications:
  • 2 years of experience in Optum Waste and Error policies and procedures
  • Working knowledge of the healthcare insurance/managed care industry
  • Previous experience in claim processing, healthcare provider information and healthcare billing practices
  • Working knowledge of medical terminology and claim coding
  • Strong written and verbal communications skills
  • Strong customer service skills
  • Ability to work in a team
  • Proficient with personal computers, including Microsoft Suite of products
  • Required Coding Certificate or Nursing Licensure, for example
    • Certified Inpatient Coder (CIC)
    • Certified Outpatient Auditor (COC)
    • Certified Professional Medical Auditor (CPMA)
    • Certified Coding Specialist (CCS)

 

Preferred Qualifications:

  • Strong analytical and problem solving skills
  • Previous presentation or policy documentation experience

 

 

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)

 

 

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