Manager of Network Audit and Recovery - Wauwatosa, WI or telecommute - Full-time / Part-time

Expanding access to affordable, high quality health care starts here. This is where some of the most innovative ideas in health care are created every day. This is where bold people with big ideas are writing the next chapter in health care. This is the place to do your life's best work.(sm)The Manager of Network Audit and Recovery is responsible for performing comprehensive research and identifying billing abnormalities, questionable billing practices, and/or irregularities. Managers of Network Audit and Recovery will investigate, research, and analyze claims data, applying knowledge of medical or pharmacy policy to determine details of fraudulent or abusive billing activity. Responsibilities also include conducting internal and on-site audits of provider records, clinical records, and itemized bills so as to ensure appropriateness of billing practices and application of medical policy; identifying and documenting fraudulent or erroneous activity during an audit; determining actual overpayment that may have occurred. Additional responsibilities may include Sarbanes-Oxley, SAS70, or Medicare Part D audit compliance.Primary Responsibilities:

Set team direction, resolve problems and provide guidance to members of own team
May oversee work activities of other supervisors
Adapt departmental plans and priorities to address business and operational challenges
Influence or provide input to forecasting and planning activities
Make product, service or process decisions that are most likely to impact multiple groups of employees and/or customers (internal or external)

Required Qualifications:

Undergraduate degree or equivalent experience
5+ years of experience in the health care industry, preferably in an auditing role
2+ years of supervisory experience
3+ years of experience performing comprehensive research to identify billing abnormalities, questionable billing practices, and/or irregularities
3+ years of experience investigating, researching, and analyzing claims data applying knowledge of medical or pharmacy policy to determine details of fraudulent or abusive billing activity
Intermediate level of proficiency in performing financial analysis including statistical calculation and interpretation
3+ years of experience with claims processing systems such as UNET, COSMOS, Facets, Diamond, etc.
Excellent written and verbal communication skills
Excellent time management and prioritization skills in order to meet multiple deadlines
Intermediate level of proficiency with Microsoft Excel, Word and Access
Preferred Qualifications:

3+ years of experience with contracting/rate audits
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.
 
Job Keywords: Healthcare, Managed Care, Audit, Recovery, Research, Claims, Claims Processing, Research, Billing, Investigating, Fraudulent, Abusive Billing Activity, Medical Coding, Supervisor, Manager, Wauwatosa, WI, Wisconsin, telecommute, telecommuter, telecommuting, work from home, remote, travel