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Hours Full-time, Part-time
Location Franklin, TN
Franklin, Tennessee

About this job


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.

The Senior Recovery/Resolution Analyst will work with a team on researching issues to determine feasibility of reducing medical costs through prospective solutions of claim system processes and claim business rules.

Positions in this function are responsible for
investigating, recovering and resolving all types of claims as well as
recovery and resolution for health plans, commercial customers and
government entities. May include initiating telephone calls to members,
providers and other insurance companies to gather coordination of
benefits data. Investigate and pursue recoveries and payables on
subrogation claims and file management. Process recovery on claims.
Ensure adherence to state and federal compliance policies, reimbursement
policies and contract compliance. May conduct contestable
investigations to review medical history. May monitor large claims
including transplant cases.

Primary Responsibilities:
  • Examine, assess, and document business operations and procedures to ensure data integrity, data security and process optimization.
  • Investigate, recover, and resolve all types of claims as well as recovery and resolution for health plans, commercial customers, and government entities
  • Investigate and pursue recoveries and payables on subrogation claims and file management
  • Initiate phone calls to members, providers, and other insurance companies to gather coordination of benefits information
  • Process recovery on claims
  • Ensure adherence to state and federal compliance policies, reimbursement policies, and contract compliance
  • Use pertinent data and facts to identify and solve a range of problems within area of expertise
  • Undergraduate degree is strongly preferred in Business, Statistics, Computer Science, Accounting or related field.
  • 3+ years experience in the health care industry, preferably in claims and/or auditing role.
  • 3+ years experience with claims processing systems such as CSP, FACETS, UNISON, or DIAMOND is preferred.
  • Medical coding experience is a plus.
  • 2+ years experience performing financial analysis, reporting and building knowledge of statistical calculation and interpretation.
  • Strong computer skills (Advanced knowledge of Microsoft Excel is required; Microsoft Access is a plus).
  • Medicaid claims and/or auditing experience is strongly preferred.
  • Ability to identify and understand the data needs of a growing organization.
  • Structure and prepare analysis to support and lead decision making.
  • Strong verbal and written communication skills.
  • Strong interpersonal skills and ability to interact with multiple departments and management.
  • Ability to prioritize time.
  • Work on multiple tasks with ongoing deadlines.
  • Generally work is self-directed and not prescribed.
  • Works with less structured, more complex issues.
  • Serves as a resource to others.

Requirements

Requirements:

  • High school diploma or GED.

  • 1+ years of knowledge of Medicare & Medicaid reimbursement methodologies

  • Strong intermediate knowledge of Microsoft Excel

  • 2+ years of experience auditing, adjusting or processing claims within a healthcare office setting

  • 1+ years knowledge of claims coding used for billing purposes
Assets:

  • Bachelor's degree preferred

  • Microsoft Access preferred

  • Experience with UHG systems - COSMOS & NICE

  • Experience with CMSPC Pricer or CCI Edits (system tools used for Medicare Claims)

  • Familiarity with Coordination of Benefits
Physical Requirements and Work Environment:
  • Frequent speaking, listening using a headset, sitting, use of hands/fingers across keyboard or mouse, handling other objects, long periods working at a computer
  • Service center environment with moderate noise level due to Representatives talking, computers, printers, and floor activity
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.



Diversity creates a healthier atmosphere: 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.