Data Mining Auditor - Wauwatosa, WI or US Telecommute - Full-time / Part-time

Position 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 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.The Data Mining Auditor 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. Primary Responsibilities:Examine,
assess, and document business operations and procedures to ensure data
integrity, data security and process optimizationInvestigate,
recover, and resolve all types of claims as well as recovery and
resolution for health plans, commercial customers, and government
entitiesInvestigate and pursue recoveries and payables on subrogation claims and file managementInitiate phone calls to members, providers, and other insurance companies to gather coordination of benefits informationProcess recovery on claimsEnsure adherence to state and federal compliance policies, reimbursement policies, and contract complianceUse pertinent data and facts to identify and solve a range of problems within area of expertiseMedicare claims and/or auditing experience is strongly preferredIdeal candidate will have experience working with CMS PC Pricer or understand CCI edit rules

Required Qualifications: High School Diploma or GED 2+ years of experience with claims auditing and researching claims information (reviewing the claim to ensure set up correctly) 1+ years of experience analyzing data 3+ years of experience in healthcare Experience working with medical claims platforms/processing systems Basic experience with Microsoft Word (creating, editing, copying, and saving documents) Basic experience with Microsoft Excel (creating, editing, copying, and saving documents)Preferred Qualifications: Bachelor's Degree or higher Project management experience Knowledge of Medicaid/Medicare Reimbursement methodologies Cosmos or NICE claims platform experience Basic proficiency with Microsoft Access (read basic data) Contract Auditor and/or Contract Setup experience Soft Skills: Analytical Mindset Strong verbal and written communication skills. Strong interpersonal skills and ability to interact with multiple departments and management 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 deadlinesPhysical 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 activityCareers 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: 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: Data, Analyst, UHG, Auditor, Audit, Senior, Analyze