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in Eden Prairie, MN
Senior Recovery Resolution Analyst - Eden Prairie, MN - Full-time / Part-time
Hours | Full-time, Part-time |
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Location | Eden Prairie, MN Eden Prairie, Minnesota |
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.
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Arial">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.
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Arial">Primary Responsibilities:
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Arial">Responsible for collecting and evaluating tips and referrals from
sources including a toll-free hotline and a web portal which can be
accessed by members, customer service, network, sales, etc.
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Arial">Evaluation and prioritization of allegations/tips and focused data
querying and referral to the appropriate internal team
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Arial">Review member claim history, perform member and provider interviews
and review medical documentation
Arial">Submit MEDIC Referrals as required
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Arial">Ensure adherence to state and federal compliance policies,
reimbursement policies and contract compliance
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Arial">Adhere to turn around time standards
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Arial">Meet and maintain minimum quality and productivity standards
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Arial">Acts as a resource for others
Arial">Generally work is self-directed and not prescribed.
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Arial">Works with less structured, more complex issues.
"Times New Roman"">- Ability to multi-task, this includes ability to understand multiple
products and multiple levels of benefits within each product
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Requirements
Requirements:
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Arial">HS Diploma/GED required
Arial">2+ years of experience with claims auditing and researching claims
information
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Arial">2+ year of experience analyzing data and identify cost saving
opportunities
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Arial">2+ year of experience in claims processing systems and guidelines/
processes
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Arial">Intermediate skills with MS Excel
Arial">Moderate proficiency with computer and Windows PC applications,
which includes the ability to learn new and complex computer system
applications
mso-bidi-font-family:"Times New Roman"">- Knowledge of Medicaid/Medicare Reimbursement methodologies
Arial"> Assets:
"Times New Roman"">Bachelor's Degree preferred
Arial">Experience working with medical claims platforms (COSMOS, UNET,
FACETS)
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Arial">Beginner proficiency MS Access- Investigational and/or
auditing experience
mso-bidi-font-family:"Times New Roman""> - Experience in a
production environment - Coding Certification
- At least 2+ year of CPT/HCPCS/ICD-9 coding experience with a thorough knowledge of health insurance business, including knowledge of industry terminology, and regulatory guidelines.
Arial">Physical Requirements and Work Environment:
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Arial">Frequent speaking, listening using a headset, sitting, use of
hands/fingers across keyboard or mouse, handling other objects, long
periods working at a computer
Arial">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 three focused businesses
organized around one giant objective; make health care 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 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. It's a culture of optimism that's not like
any place you've ever worked. OptumRx, OptumInsight, OptumHealth. Three
incredible ideas in one incredible company and a singular opportunity to do
your life's best work.
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Diversity
creates a healthier atmosphere: All qualified applicants will receive
consideration for employment without regard to race, color, religion, sex,
national origin, protected veteran status, or disability status.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a
drug test before beginning employment. In addition, employees in certain
positions are subject to random drug testing.