Job details
Job type full-time
Full job description
Optum is a company that`s on the riseWe`re expanding in multiple directions, across borders and, most of all, in the way we thinkHere, innovation isn`t about another gadget, it`s about transforming the health care industryReady to make a difference? make yourself at home with us and start doing your life`s best work.(sm)
You’ll enjoy the flexibility to telecommute* from anywhere within the u.sAs you take on some tough challenges.
Primary responsibilities:
Review mass claims data and conduct analysis to look for patterns of potential waste and error billing aberrancies
Utilizing information from claims data analysis, plan members, providers and other sources to conduct a desk audit, document relevant findings
Using statistically random sampling, interact with medical providers to request and receive medical records
Receive, document and maintain inventory of medical records
Review claim and case history and compare medical documentation against procedural codes billed
Conduct clinical/coding audits (utilizing appropriate personnel) to gather and analyze all necessary information and documents related to the audit
Conduct telephonic interviews of members, providers, and/or additional contacts to gather information to support the audit
Adhere to state and federal compliance policies, reimbursement policies and contract compliance
Support compliance, regulatory and legal on case actions
Prepare overpayment documents in accordance with business, legal and state/federal requirements
Interact with medical providers and potentially their legal representatives to successfully negotiate/settle the identified overpayment
Ability to train/support new hires along with applying quality checks for new and tenured employees
Adhere to individual metrics related to production, quality and business goals
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 or ged (or higher)
3+ years of working knowledge in the healthcare insurance/managed care industry
3+ years of experience in a position performing audits and recoveries related to healthcare fraud, waste, abuse or error
Working knowledge of claim recoveries, healthcare provider information and healthcare billing practices
Working knowledge of medical terminology and claim coding
Intermediate proficiency in microsoft word, excel, outlook (ability to create, edit and save documents / spreadsheets, pivot tables and graphs, e-mail, and calendar management)
Preferred qualifications:
2+ years of post payment experience working in a fraud waste and abuse (‘fwa’) or special investigations unit (“siu”) environment
Medicare/medicaid program knowledge
Experience with data analysis as it relates to financial recovery / settlements
Experience using facets claim platform with the ability to conduct research
Exceptional written, verbal, analytical, organizational, time management, and problem-solving skills.
Solid interpersonal skills required with an objective collaborative approach
Ability to adapt in a dynamic and fast paced changing work environment
Ability to work independently
Unitedhealth group requires all new hires and employees to report their covid-19 vaccination status.
Careers at optumcareWe`re on a mission to change the face of health careAs the largest health and wellness business in the us, we help 58 million people navigate the health care system, finance their health care needs and achieve their health and well-being goalsFortunately, we have a team of the best and brightest minds on the planet to make it happenTogether we`re creating the most innovative ideas and comprehensive strategies to help heal the health care system and create a brighter future for us allJoin us and learn why there is no better place to do your life`s best work.(sm)
Optumcare is committed to creating an environment where physicians focus on what they do best: care for their patientsTo do so, optumcare provides administrative and business support services to both owned and affiliated medical practices which are part of optumcareEach medical practice part and their physician employees have complete authority with regards to all medical decision-making and patient careOptumcare’s support services do not interfere with or control the practice of medicine by the medical practices or any of their physicians.
Colorado residents only: the salary range for colorado residents is $53,300 to $95,100Pay is based on several factors including but not limited to education, work experience, certifications, etcIn 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.
*all telecommuters will be required to adhere to unitedhealth group’s telecommuter policy.
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 workplaceCandidates are required to pass a drug test before beginning employment.
Job keywords: senior post pay investigator, telecommute, telecommuter, telecommuting, work at home, work from home, remote
