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Clinical Investigator - US Telecommute or Any Optum Location
•30 days ago
| Hours | Full-time, Part-time |
|---|---|
| Location | Minnetonka, MN Minnetonka, Minnesota |
About this job
Position Description:
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.
Positions in this function are responsible for investigating, reviewing, and resolving Professional and/or Facility provider claims on behalf of our commercial and government customers and their health plans. This may include participation in telephone calls or meetings with providers, clients and other investigative areas. Ensure adherence to state and federal compliance policies, reimbursement policies and contract compliance.
Primary Responsibilities:
- Investigates, reviews, and provides clinical and/or coding expertise in the application of medical and reimbursement policies within the claim adjudication process through file review. This could include Medical Director/physician consultations, interpretation of state and federal mandates, applicable benefit language, medical and reimbursement policies and consideration of relevant clinical information.
- Performs clinical coverage review of post-service claims, which requires interpretation of state and federal mandates, applicable benefit language, medical & reimbursement policies, coding requirements and consideration of relevant clinical information on claims with aberrant billing patterns.
- Performs clinical coding review to ensure accuracy of medical coding and utilizes clinical expertise and judgment to determine correct coding & billing.
- Identifies aberrant billing patterns and trends, evidence of fraud, waste or abuse, and recommends providers to be flagged for review.
- Maintains and manages daily case review assignments, with a high emphasis on quality.
- Provides clinical support and expertise to the other investigative and analytical areas.
- Participates in provider/client/network meetings, which may include provider education through written communication.
- Participates in training of new staff, and serves as a clinical resource to other areas within the clinical investigative team.
Requirements
Requirements:
- High School Diploma/GED
- Unrestricted RN/LPN license OR Certified Coder
- 2+ years of current coding experience
- 2+ years of CPT/HCPCS/ICD-9 coding experience with a thorough knowledge of health insurance business, including knowledge of industry terminology, and regulatory guidelines
- Bachelor's degree
- Healthcare Claims experience
- Managed care experience
- Investigational and/or Auditing experience
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 computer
- Service center environment with moderate noise level due to Representatives talking, computers, printers, and floor activity
At
Optum, you will perform within an
innovative culture that's focused on transformational change in the Healthcare
system. You will leverage your skills across a diverse and multifaceted
business. And you will make contributions that will have an impact that's
greater than you've ever imagined.
Diversity creates a healthier atmosphere: 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.
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