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Recovery Resolution Consultant - Ideation Analyst - Franklin, TN or US Telecommu
Job Description
Position Description:
Welcome to one of the toughest and most fulfilling ways to help people, including yourself. We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement. Join us and start doing your life's best work.
Primary Responsibilities:
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 17 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.
Welcome to one of the toughest and most fulfilling ways to help people, including yourself. We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement. Join us and start doing your life's best work.
Primary Responsibilities:
- Identify patterns of claim payment abnormalities that will lead to new rule development through data and claim analysis
- Identify patterns of claim payment abnormalities that will lead to one off payment error identification
- Research new leads for viability
- Populate client's test file templates and gather all supporting documentation for trend approval
- Assist on client calls with the presentation of new rules for client approval
- Facilitate new rule kick off calls with Operations, Centers of Excellence, and the recovery team
- Weekly management reports outlining work completed and issues encountered
- Competencies and Best Practices for High Performers
- Breakdown complex problems into individual root causes
- Perform vendor analysis and present findings to management teams
- Quickly identify payment errors regardless of claim system by means of data analysis
- Identify and refine criteria to successfully increase efficiency of rule logic
- Serve as a team lead in the absence of the Operations Manager
- Subject matter expert on client processes and policies
- Assist management and sales with product assessments for new business
- Train analysts within and outside of Operations
- Lead special projects with little to no manager supervision or assistance
- Perform validation steps for new client implementations
Required Qualifications:
- Bachelor's Degree (or higher) or High School Diploma / GED and 3+ years of health care experience working with claims data and / or medical codes
- 2+ years of health care experience working with claims data and / or medical codes
- Experience analyzing large data sets to determine trends / patterns
- Experience reading and interpreting provider contracts, fee schedules, and claim payment policies
- Intermediate level of proficiency working with Microsoft Excel including formulas, calculations, charts, graphs, etc.
- Experience with Medicaid payment policies
- Coding Certification: CPC, CPC-P, COC, CCS, or CCA, CCS-P
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: UnitedHealth Group, Optum, claims, claims data, coding, healthcare, medical codes, claim payment, medicare, medicaid
Job Summary
Start Date
As soon as possible
Employment Term and Type
Regular, Full Time
Required Education
High School or Equivalent
Required Experience
3+ years
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