Commercial Data Mining COB Analyst - Franklin, TN - Full-time / Part-time

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.SM 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 informationProcess 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 May conduct contestable investigations to review medical history. May monitor large claims including transplant cases.Generally work is self-directed and not prescribed.Works with less structured, more complex issues.Serves as a resource to others.

Requirements:

 

High School Diploma/GED 1+ years of relevant experience (healthcare billing, claims,
auditing, reimbursement, or data analysis. 

Assets:

 

Bachelors DegreeExperience working with medical
claims platforms
2+ years of experience with
claims auditing and researching claims information 1+ year of experience analyzing
data and identify cost saving opportunities Knowledge of Medicaid/Medicare
Reimbursement methodologies Computer proficiency in
Microsoft Office (Word, Excel, Outlook) Experience in healthcare Knowledge of claims processing
systems and guidelines/processes Experience performing advanced
analysis, formulas, data capture, charts, graphs, and presentations with MS Excel


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 computerService 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.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.Kewords claims, medical claims, healthcare claims, claims processing, claims processor; office, UnitedHealth Group, UnitedHealthcare,  training class, customer service representative, customer service, CSR, Data Entry, adjustments, phone support