Recovery / Resolutions Analyst - Portland, ME - 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.


Optum is part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system.If you get excited about the life transforming potential of bringing health care information to the right place, at the right time, to support crucial decisions, welcome to Optum.We're one of the largest and fastest growing health information companies and the only organization in our industry with the information, technology and consulting expertise to solve the most significant challenges in health and human services.As a vital member of the UnitedHealth Group family, we serve customers in every segment of the health care field. This includes government agencies, pharmaceutical companies, hospitals and health delivery networks, insurance providers and, of course, the diverse business divisions of UnitedHealth Group.Bring your talent to an industry leader with the information, technology, and consulting expertise to help transform health and human services. No matter what your role, you'll be empowered to ask more questions, develop better solutions and help make the health care system greater than ever.

Primary Responsibilities:


Investigate and resolve all types of claims for health plans, commercial customers, and government entities
Receive and initiate phone calls to providers to gather pertinent information and documentation for review activity
Handle faxes and mail from healthcare providers.
Provide education pertaining to audits.
Compile documentation and analyze the provider disputes for accuracy and completeness by providing explanations and interpretations within area of expertise.
Manage assigned projects, participate in dispute hearings and administrative hearings.
Ensure adherence to state and federal compliance policies, reimbursement policies, and contract compliance

Requirements:

High School Diploma/ GED required
Certified Professional Coder (CPC) required
2+ years of medical claims coding & processing experience
1+ year experience working with Medicaid, Medicare and Commercial Insurance entities as well as with paid claims data required
Experience in using Excel to create and maintain spreadsheets, merge cells,
Experience in using Outlook to send emails, create appointments and use webex
Assets:


Previous call center experience communicating with providers and educating them on their reviews
Associate's degree or higher

Careers 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.

Keywords: Recovery Resolutions Analyst, Portland, Maine, Claims, Medical claims, coding, CPC, Medicaid, Medicare, Commercial Insurance Entities, UnitedHealth Group, Optum