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Facility Clinical Resolution Senior Analyst - US Telecommute

  • Jobs With Remote
  • S Arizona Ave, Chandler, AZ, USA
  • Apr 12, 2019

Job Description

Energize your career with one of Healthcare's fastest growing companies.

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 5 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 and resolving all types of claims for health plans, commercial and government entities. Position will include providing support for incoming provider calls, initiating calls to providers to gather medical claim documentation, analyze documentation and ensure adherence to state and federal compliance policies, reimbursement policies and contract compliance. Certified Coding experience required.


* Compile medical documentation and review for accuracy and completeness
* Participate in all meetings and training sessions to understand specifics of auditing each claim type
* Manage assigned projects
* Analyze documentation, review provider disputes, summarize specifics of review results for all claim types (Inpatient Facility /(DRG) / Outpatient Facility)
* Identify and analyze billing trends - report results as required.
* Provide explanations and interpretations within area of expertise
* Attend and participate with provider reviews
* Assist with training of new analysts
* Perform prepayment claims review analysis
* Review medical records to confirm appropriate medical coding
* Document clinical determinations in prepayment review system
* Ensure compliance with industry standard coding guidelines and State regulatory guidelines as appropriate.


* High School Diploma/GED (or higher)
* Certified Professional Coder (CPC)
* 3+ years of CPT/HCPCS/ICD-9/ICD-10 coding experience with a thorough knowledge of facility claims
* 2+ years of experience reviewing/coding medical records
* 1+ year of experience analyzing data and identifying cost saving opportunities
* 1+ year of experience auditing claims and researching claims information
* Moderate proficiency of Microsoft MS Office including:
* Word (create/edit/save documents, work within templates)
* Excel (data entry, sorting/filtering, edit/save spreadsheets)


* Unrestricted RN, unrestricted LVN, unrestricted LPN, current certified coder, or RHIT
* Certified Professional Medical Auditor (CPMA)
* Certified Coding Specialist (CCS)
* Certified Inpatient Coder (CIC)
* Certified Outpatient Auditor (COC)
* Associate Degree (or higher)
* Knowledge of Medicaid / Medicare reimbursement methodologies
* Experience working in the healthcare industry with claims and or recovery.

Soft Skills:

* Excellent analytical, verbal and written communications skills

Physical Requirements and Work Environment:

* Frequent sitting, use of hands/fingers across keyboard or mouse, handling other objects, long periods working at a computer

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: facility claims, CPC, coder, medical records, coding, audits, auditing, nurse, auditor, Telecommute