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Recovery Resolution Senior Analyst - Clinical - US Telecommute

Company: UnitedHealth Group
Location: Tampa
Posted on: October 13, 2019

Job Description:

Energize your career with one of Healthcare’s fastest growing companies. You dream of a great career with a great company – where you can make an impact and help people. We dream of giving you the opportunity to do just this.  And with the incredible growth of our business, it’s a dream that definitely can come true. Already one of the world’s leading Healthcare companies, UnitedHealth Group is restlessly pursuing new ways to operate our service centers, improve our service levels and help people lead healthier lives.  We live for the opportunity to make a difference and right now, we are living it up. This opportunity is with one of our most exciting business areas: Optum – a growing part of our family of companies that make UnitedHealth Group a Fortune 6 leader. Optum helps nearly 60 million Americans live their lives to the fullest by educating them about their symptoms, conditions and treatments; helping them to navigate the system, finance their healthcare needs and stay on track with their health goals. No other business touches so many lives in such a positive way. And we do it all with every action focused on our shared values of Integrity, Compassion, Relationships, Innovation & Performance. Investigate Optum Waste and Error stopped claims by gathering information, researching state and federal guidelines, and following internal procedure to determine the viability of the claim for further review in a production environment. Primary Responsibilities: Clinical Case Reviews: Perform clinical review of professional (or facility) claims vs. medical records to determine if the claim is supported or unsupported Maintain standards for productivity and accuracy.   Standards are defined by the department. Provide clear and concise clinical logic to the providers when necessary Other internal customer correspondence and team needs: Attend and provide feedback during monthly meetings with assigned internal customer department Provide continuous feedback on how to improve the department relationships with internal team members and departments. Continue education: Keep up required Coding Certificate and/or Nursing Licensure (if applicable) Complete compliance hours as required by the department 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) Must meet one or more of the following criteria: Coding Certification (CPC - Certified Professional Coder) Bachelor degree with 3+ years healthcare experience 5+ years healthcare claims processing experience Previous experience in healthcare claim processing, healthcare provider information and/or healthcare billing practices Intermediate proficiency with computer and Windows PC applications with the ability to navigate a computer using keyboard and mouse Experience using Microsoft Office products: Microsoft Word (edit/save documents), Microsoft Excel (data entry, sort/filter, edit/save spreadsheets), and Microsoft Outlook (compose/send emails) Soft Skills: Strong written and verbal communication skills Strong customer service skills Ability to work in a team Physical Requirements and Work Environment: Frequent sitting, use of hands/fingers across keyboard or mouse, handling other objects, long periods working at a computer 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: CPC, healthcare, claims, medical records, coding, audit, Telecommute

Keywords: UnitedHealth Group, Tampa , Recovery Resolution Senior Analyst - Clinical - US Telecommute, Other , Tampa, Florida

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