JobsEQ by Chmura Logo

Recovery / Resolution Analyst - Remote

United Health Group

Location: Tampa, FL 33646
Type: Full-Time, Remote
Posted on: May 16, 2022
This job is no longer available from the source.
NEW
Full Time | Work From Home
Full Time | Work From Home
You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
The OptumHealth Behavioral Solutions (OHBS) SIU Recovery Resolution Analyst is responsible for investigating, recovering and resolving suspect and/or potentially fraudulent Behavioral Health claims that have been flagged for review of claims as well as recovery and resolution for health plans, commercial customers and government entities. Utilizing a combination of technological platforms, designated resource tools and individual expertise, the individual is expected to work through daily claims files to make line level adjustment on appropriateness of payment. This position serves as a recovery and resolution expert in the SIU as part of its overall fraud, waste and abuse (FWA) recoveries.
This position is full-time, Monday - Friday. Employees are required to work our normal business hours of 8:00am – 5:00pm CST. It may be necessary, given the business need, to work occasional overtime or weekends.
*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.
Primary Responsibilities:
• Conducts detailed reviews on claims that have been indentified as suspicious and/or potentially fraudulent, utilizing most current reference materials to include, but not limited to: Current Procedural Terminology (CPT), Internal Classification of Disease-9th Edition (ICD-9), and Healthcare Common Procedure Coding System (HCPCS) guidelines.
• Documents decisions on denied claims with thorough notations, and enters these notes into company designated systems. Must be able to discuss these decisions with SIU team members, inter-departmental personnel, providers, law enforcement, state and federal agencies or designated billing personnel as required to educate and correct billing issues.
• Receives and scans incoming SIU appeals, reevaluate previous claim decisions based on provided documentation and research coordinate with company personnel as required in making final determination, and informs providers of decisions.
• Coordinate with SIU team members to continually provide updates on newly indentified billing/coding trends, suspicious providers, gaps in clinical policy, provider contract issues, system configuration and pricing errors, claims processor errors (manual or system processed), and provide leads on potential post-payment investigations.
• Monitor and participate with national and regional information sharing groups with a focus on collecting data to recognize national trends or schemes to proactively anticipate threats.
• Receives and resolves claims adjustments related to SIU recoveries and reconsiderations.
• Acts as SIU Claims resource for all lines of business.
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)
• Experience with one or more of the following:
• Claim processing
• Provider demographic information
• Insurance billing practices
• Intermediate to advance experience with Microsoft Office – Microsoft Excel (sort and filter data) and Microsoft Word (create and edit documents)
• Experience using claims platforms such as UNET, Pulse, NICE, Facets, Diamond, etc.
• 1+ years of experience analyzing and solving customer problems
• 2+ years of claims or collections experience
Telecommuting Requirements:
• Required to have a dedicated work area established that is separated from other living areas and provides information privacy
• Ability to keep all company sensitive documents secure (if applicable)
• Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service
Preferred Qualifications:
• Experience in anti-FWA activities to include SIU or Program Integrity Units/Programs or Overpayment Recovery teams.
• Intermediate level knowledge of CMS 1500 and UB04 data elements.
• Intermediate level of standard industry coding guides such as CPT, HCPCS, ICD-9, and Revenue Codes.
Soft Skills:
• Strong organizational/time management skills and be able to work independently, exercising judgment and utilizing claims and coding expertise.
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 $20.77 - $36.88. The salary range for Connecticut / Nevada residents is $22.93 - $40.58. 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.
Keywords: #RPO, #YELLOW
Location/Region: Tampa, FL (33646)