Medical Claims Investigator – Remote

UnitedHealth Group
Published
July 18, 2021
Location
Atlanta, GA
Category
Job Type

Description

You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Combine two of the fastest - growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making Healthcare data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life’s best work.SM

It is Optum’s mission and intent to protect members, providers, business partners, employees and stakeholders by administering a strong and effective anti-FWAE program designed to prevent, detect, investigate and resolve incidents of potential FWAE, with a focus on education and prevention. Our Company is committed to addressing and correcting known offenses, recovering lost funds, improving overall anti-FWAE ability and partnering with state and federal agencies. Optum supports this commitment to protecting members, providers and other healthcare stakeholders through technologically advanced tools and the administration of a strong and balanced review process to ensure industry standards regarding documentation and billing of services are met.

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. 

This position is full-time (40 hours/week) Monday - Friday during normal business hours of 8:00am – 5:00pm. It may be necessary, given the business need, to work occasional overtime. We offer 2 weeks of paid training. The hours during training will be 8:00am to 4:30pm Monday-Friday. Training will be conducted virtually from your home.

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

Primary Responsibilities:

  • 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.
  • 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.
  • Keep up required Coding Certificate and/or Nursing Licensure.
  • Complete compliance hours as required by the department.

This is a challenging role with serious impact. You’ll need to sort through complex situations to understand and clarify where errors happened or where they may continue to happen. It’s a fast-paced environment that takes focus, intensity and resilience.

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)
  • 2+ years of experience in Medical record coding with experience in Evaluation and Management Services in the outpatient/office setting.
  • Working knowledge of the healthcare insurance/managed care industry.
  • 2+ years of experience in claim processing, healthcare provider information and healthcare billing practices
  • Working knowledge of medical terminology and claim coding.
  • Proficient with personal computers, including Microsoft Suite of products; Microsoft Excel (create, edit, sort, filter, pivot tables) and Microsoft Access (create, edit, format, manipulate data)
  • Certified Professional Coder (CPC) 
  • 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 similar UnitedHealth Group-approved symptom screener. When in a UnitedHealth Group building, employees are required to wear a mask in common areas. In addition, employees must comply with any state and local masking orders

Preferred Qualifications:

  • Certified Inpatient Coder (CIC)
  • Certified Outpatient Auditor (COC)
  • Certified Professional Medical Auditor (CPMA)
  • Certified Coding Specialist (CCS)
  • Previous presentation or policy documentation experience preferred.

 Telecommuting Requirements:

  • Required to have a dedicated work area established that is separated from other living areas and provides information privacy
  • Ability to keep all company sensitive documents secure (if applicable)
  • 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.
  • Strong customer service skills.
  • Strong analytical and problem-solving skills.
  • Ability to work in a team.

UnitedHealth Group is an essential business. The health and safety of our team members is our highest priority, so we are taking a science driven approach to slowly welcome and transition some of our workforce back to the office with many safety protocols in place. We continue to monitor and assess before we confirm the return of each wave, paying specific attention to geography-specific trends. At this time, 90% of our non - clinical workforce transitioned to a work at home (remote) status. We have taken steps to ensure the safety of our 325,000 team members and their families, providing them with resources and support as they continue to serve the members, patients and customers who depend on us.

You can learn more about all we are doing to fight COVID-19 and support impacted communities at: https://www.unitedhealthgroup.com/newsroom/addressing-covid.html

Military & Veterans find your next mission:  We know your background and experience is different and we like that. UnitedHealth Group values the skills, experience and dedication that serving in the military demands. In fact, many of the values defined in the service mirror what the UnitedHealth Group culture holds true: Integrity, Compassion, Relationships, Innovation and Performance. Whether you are looking to transition from active duty to a civilian career, or are an experienced veteran or spouse, we want to help guide your career journey. Learn more at https://uhg.hr/transitioning-military

Learn how Teresa, a Senior Quality Analyst, works with military veterans and ensures they receive the best benefits and experience possible. https://uhg.hr/vet

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

Colorado Residents Only: The hourly range for Colorado residents is $25.63 to $45.72. 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.

Keywords: Optum, Healthcare, Recovery, Resolutions, Clinical, Collections, RN, LVN / LPN, medical coding, work at home, work from home, WAH, WFH, remote, telecommute, hiring immediately, #RPO

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