Senior Recovery Resolution Analyst - National Remote

You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.
Individual will investigate Optum Waste and Error stopped claims by gathering information, researching state and federal guidelines, and following internal procedures to determine the viability of the claim for further review. Individual will perform clinical review of Outpatient Facility claims and medical records to determine if claims are supported or unsupported for payment. Business is a production-based environment.
This position is full-time, Monday - Friday. Employees are required to work our normal business hours of 8:00am – 5:00pm. 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

• Clinical Case Reviews - 75%
• Perform clinical review of facility claims and medical records to determine if the claim is supported or unsupported for payment
• Continuing Education – 10%
• Complete compliance hours as required by the department
• Provide continuous feedback on how to improve the department relationships and performance with internal team members and departments.
• Maintain standards for productivity and accuracy. Standards are defined by the department.
• Provide clear and concise clinical logic to the providers when necessary
• Attend and provide feedback during monthly meetings with assigned internal customer department.
• Keep up required Coding Certificate and/or Nursing Licensure
• Other internal customer correspondence and team needs – 15%

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

• Working knowledge of medical terminology and claim coding
• High School Diploma / GED (or higher) OR 10+ years equivalent experience
• Certified Outpatient Auditor (COC)
• Coding Certificate or Nursing Licensure, for example:
• Medical record coding experience with experience in Evaluation and Management Services in the outpatient/office setting
• Working knowledge of the healthcare insurance/managed care industry
• Previous experience in claim processing, healthcare provider information and healthcare billing practices
• Certified Coding Specialist (CCS)
• Ability to work our normal business hours of 8:00am to 5:00pm, Monday - Friday

Preferred Qualifications

• Previous presentation or policy documentation experience

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

• Strong written and verbal communications skills
• Ability to work in a team
• Strong analytical and problem-solving skills
• Strong customer service skills

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
California, Colorado, Connecticut, Nevada, Washington or New York, Rhode Island Residents Only: The salary range for California / Colorado / Connecticut / Nevada / Washington / New York / Rhode Island residents is $27.07 - $53.08.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.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.
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.
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