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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 / Resolutions Representative - Frederick, MD

UHG - Frederick, Maryland

Posted: 11/12/2018

The health care system is still evolving at a rapid pace. Technology is driving new advances in how patient care is delivered and how it’s reimbursed. Now, UnitedHealth Group invites you to help us build a more accurate and precise approach to claims adjudication.


The Claims Recovery Services Team is a responsible for working directly with health care providers to coordinate recovery / collection of over - payments.  The team reviews over - payment situations, resolve, and recover dollars for health plans, commercial customers, and government entities. This position handles overpaid claim inventory through telephone contact with the provider, which includes physician, facility, labs, etc. You’ll have all the tools and backing you need to help manage and ensure adherence to compliance policies. All the while, you’ll be building your career with a leader and reaching for the highest levels of performance as you do your life's best work.SM


This is a challenging role with serious impact. You’ll need to sort through complex situations to understand and clarify where errors happened or where they may continue to happen. It’s a fast - paced environment that takes focus, intensity and resilience.


Primary Responsibilities:

  • Make outbound calls to providers to discuss and resolve outstanding over - payments (95% of your day can be on phones)
  • With a focus on building a strong working rapport with the provider representatives to review and discuss over - payment situations and provide detailed explanations to the providers in both verbal and written format
  • Escalate recovery efforts through many avenues to progress and resolve the situations
  • Strive to meet and exceed quality production defined goals (calls / contacts), including a financial target
  • Ensure adherence to state and federal compliance policies, reimbursement policies and contract compliance
  • Complete required documentation on all recovery efforts on a timely basis in the appropriate claims platforms
  • Perform other duties as assigned


Required Qualifications:

  • High School Diploma / GED or equivalent work experience
  • 1+ Medical Claims, Professional Billing, and / or Collections
  • 1+ year of experience analyzing and solving customer problems

Preferred Qualifications:

  • Bachelor’s Degree or higher
  • Experience working in the health care industry  
  • Medical healthcare terminology a plus
  • Experience using 2 or more of the following Claims Platforms:  ODAR, UNET, COSMOS, CPW, ISET, NICE, FACETS, CSP and / or Oxford       

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


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.


Keywords: Optum, Healthcare, Recovery, Resolutions, Customer Service, Claims, Billing, Collections, COSMOS, CPW, ISET, NICE, FACETS, CSP, Oxford, UNET, ODAR

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