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in San Bernardino, CA

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Hours Full-time, Part-time
Location San Bernardino, CA
San Bernardino, California

About this job

Position Description:





Careers with MARCH® Vision Care. Now this
is a place where you can bring your compassion and desire to innovate. MARCH® Vision Care was built with a groundbreaking platform
in mind for delivering quality vision care — one that not only focuses on early
disease detection, but also uses state-of-the-art technology to help improve
communication between members and their doctors. As part of the UnitedHealth
Group family of businesses, we specialize in the administration of vision care
benefits for managed care organizations, specifically for government sponsored
programs such as Medicaid, Medicare, Medicare-Medicaid Plans, and Healthcare Exchange.
Join our team and you’ll quickly realize this is the opportunity to do your
life’s best work.SM



Responds to comprehensive delegated
audits across all states. Prepares audit universes and ensures supporting
documentation is complete and accurate for claims processing, customer
services, provider rosters, provider contracting and credentialing. Develops
and implements corrective action plans in collaboration with business SMEs in
order to remediate deficiencies and key findings.Primary Responsibilities:



Keeps track of Payer Audits in a designated spreadsheet
and stores all audit related documents in individual client folders.Coordinates with the Credentialing Department to keep
track and document their credentialing audits in the Payor Audit Folder.Reviews, analyzes, and seeks clarification on universe
requests received from clients.  Submits universe requests through the ticket system and
reviews them before delivery to ensure it meets the requested
requirements.Forwards Call Center universe requests and call
selections to the manager of Customer Service for processing.Completes audit questionnaires.Gathers all information pertaining to selected claims
for audit and delivers them to the clients through secured emails, ftp
sites, hard copy disks, or in any other way specified by the client.Queries and extracts data from various databases, using
various tools including SQL, with an understanding of broad data content
available and specific table structures as part of the universe data
accuracy verification.Documents, stores, and forwards audits findings to the
Director of QAR.All other duties as assigned by management.

Requirements

Required Qualifications:
High School Diploma or GEDCandidates that choose to work remotely must be able to travel to the San Bernardino office for audits, six or more times per year.
Candidates must be able to work a day shift schedule, 40 hours per week, Monday through Friday5+ years of claims auditing experience for all claim types, with solid knowledge of CMS Regulatory Prompt Pay GuidelinesCandidates
must be proficient with MS Office Suite programs and must know how to
create, edit, copy, send and save documents, correspondence and
spreadsheets with MS Word, Excel and Outlook2+ years of Payer Delegation experience (performing oversight of claims processing activities for vendors, delegated groups, etc.)
Preferred Qualifications: 

Thorough working knowledge of ICD9 coding, CPT4 coding, HCPCS coding, CMS (HCFA DMHC/DOI guidelines and medical terminology.
Fundamental understanding of claims and customer service delegation audit procedures and protocol.Fundamental understanding of industry standard Managed Care Operations reporting practices.Relational database / MS SQL / Crystal Reports experience.Proficient in querying a large amount of data using SQL query skills.UnitedHealth Group is working to create the health care system of tomorrow. Already
Fortune 6, we are totally focused on innovation and change. We work a
little harder. We aim a little higher. We expect more from ourselves and
each other. And at the end of the day, we're doing a lot of good.Through
our family of businesses and a lot of inspired individuals, we're
building a high-performance health care system that works better for
more people in more ways than ever. Now we're looking to reinforce our
team with people who are decisive, brilliant and built for speed.Come
to UnitedHealth Group, and share your ideas and your passion for doing
more. We have roles that will fit your skills and knowledge. We have
diverse opportunities that will fit your dreams.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: UHG, San Bernardino, claims, provider, customer service, MARCH VISION