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UnitedHealth Group

UnitedHealth Group is looking for a Recovery Resolution Consultant – Telecommute  #HirePagosaSprings #PagosaSpringsJobVacancy

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. As part of our Recovery and Resolutions team, you’ll provide consultative support to our business units and external vendor organizations. You’ll handle requests, define business requirements and coordinate resolutions incorporating State/Federal regulations. Join us and build your career with an industry leader.Youll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.Primary Responsibilities: Implementation and management of Payment Integrity Programs. Perform comprehensive research and identify billing abnormalities, questionable billing practices, and/or irregularities. Manage research and analyses of claims data to determine details of fraudulent or abusive billing activity. Have oversight of audits of provider records, clinical records, and itemized bills to ensure appropriateness of billing practices. Adapt departmental plans and priorities to address business and operational challenges. Influence or provide input to forecasting and planning activities.This is a challenging role with serious impact. You’ll be assisting, educating, problem-solving and resolving challenging situations to the best possible outcomes. You’ll need to understand and interpret clients’ needs and ensure service and delivery excellence supporting the Fraud, Waste, Abuse, and Error product suite. This involves working with a high complexity solution set and cross functional teams to proactively review, research and resolve highly escalated inquiries. 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 5+ years of experience in the health care industry, in auditing, claims processing, payment integrity, claims configuration. 2+ years of experience conducting or managing comprehensive research to identify billing abnormalities, questionable billing practices, irregularities, and fraudulent or abusive billing activity Experience with Fraud, Waste, & Abuse programs Proficiency in performing financial analysis/audit including statistical calculation and interpretation. Proficiency using Microsoft Office: Word, Excel (data analysis, sorting/filtering, pivot tables), PowerPoint (prepare formal presentations and training), Visio (develop workflow processes). If you need to enter a work site for any reason, you will be required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or a similar UnitedHealth Group-approved symptom screener. Employees must comply with any state and local masking orders. In addition, when in a UnitedHealth Group building, employees are expected to wear a mask in areas where physical distancing cannot be attained.Preferred Qualifications: Undergraduate degree 1 or more of the following certifications: CPC, CPCO, AHFI, HCAFA, CFE 4+ years of experience using claims platforms such as UNET, Pulse, NICE, Facets, Diamond, etc. Experience working with federal contracts Experience with CES (Claims Editing System) or other claims clinical editing programs. Proficiency in various claims payment methodologies; to include capitation, fee-for-service,   DRG, percent-of-charge, and OPPS. Experience interpreting provider contractual agreements. Experience with writing SQL data queries.Careers with Optum. Here’s the idea. We built an entire organization around one giant objective; make health care 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)*All Telecommuters will be required to adhere to UnitedHealth Groups Telecommuter Policy.Colorado Residents Only: The salary range for Colorado residents is $64,800 to $116,000. Pay is based on several factors including but not limited to education, work experience, certifications, etc. As of the date of this posting, In addition to your salary,  UHG offers the following benefits for this position, subject to applicable eligibility requirements: Health, dental, and vision plans; wellness program; flexible spending accounts; paid parking or public transportation costs; 401(k) retirement plan; employee stock purchase plan; life insurance, short-term disability insurance, and long-term disability insurance; business travel accident insurance; Employee Assistance Program; PTO; and employee-paid critical illness and accident insurance.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.Job Keywords: Telecommute, telecommuter, telecommuting, work from home, work at home, remote, Minneapolis, MN, Minnesota, Chicago, IL, Illinois, Denver, CO, Colorado, Irvine, CA, California, Las Vegas, NV, Nevada, Phoenix, AZ, Arizona, payment integrity, auditing, claims processing, payment integrity, claims configuration Recommended SkillsAuditingMicrosoft Power PointMicrosoft OfficePresentationsResearchClaimsRecommended JobsRecovery AnalystAtlanta,GaRecovery Analyst, Atlanta,GaRecovery Resolution Consultant – TelecommuteUnitedHealth GroupWork From HomeFull-TimeDisaster Recovery Engineer IWellStar Health SystemMariettaCustomer Service RepresentativeAtlanta$50,000 – $70,000/Year

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