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Job Details


UnitedHealth Group

Appeals Coordinator - National Remote

Healthcare

Clinical Coordinator

No

Dallas, Texas, United States

You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

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.

The Appeal Coordinator will provide a full range of duties to support all team members within the Optum360 Clinical Appeals Unit (CAU). This position will participate in a wide range of activities associated with clinical appeals, including but not limited to, verifying accuracy of CAU denial cases, and tracking of denial/appeal activity in the electronic system throughout the life cycle of the denial. Appeal Coordinator will perform administrative tasks to support the Clinical Appeal Nurse; this includes completing the provider appeal packet and insurance form requirements for submission to the Plan. Additionally, the appeal coordinator will be monitoring, handling, and updating cases with Payer reimbursement post-appeal. This role will also provide support to the team lead on projects pertaining to administrative processes such as portal submissions, reports, and referrals.

This position is full-time. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00am – 5:00pm PST. It may be necessary, given the business need, to work occasional overtime.

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

Primary Responsibilities:

  • Gather all medical records, financial documents, and complete all relevant forms in relation to clinical appeal and complete provider appeal packet for submission
  • Submit appeal packet via insurance portals or via fax
  • Process provider appeal resubmission requests per protocol
  • Refer Legal Escalation cases to Vendor Management/ Legal Portal Submission
  • Maintain assigned worklists and resolve high priority and aged inventory
  • Create and update denial cases appropriately and maintains strict adherence to appeal requirements and associated timeframes
  • Scans all incoming faxes/mail to the Clinical Appeals Unit into the appropriate system and documents accordingly
  • Timely completion of all assigned tasks within appeal software with consistently accurate results
  • Manage and maintain vendor referrals
  • Provide reconciliation findings and escalate any trends or items of concern
  • Provide case detail updates to the appropriate systems as necessary
  • Scans all incoming faxes/mail to the Clinical Appeals Unit into the appropriate system and documents accordingly
  • Solves moderately complex problems and/or conducts moderately complex analysis innovative solutions
  • Works with minimal guidance; seeks guidance on only the most complex tasks and translates concepts into practice
  • Other duties and responsibilities, not specifically described, may be defined, or assigned from time to time, consistent with knowledge, skills, and abilities of the incumbent by management.

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

  • High School Diploma/GED (or higher) OR 3+ years of experience as administrative or coordinator role
  • Proficient in Windows PC use
  • Proficient Microsoft suite applications and Adobe Acrobat
  • Able to work a 40-hour schedule within the operating hours of the site, Pacific Standard Time.

Preferred Qualifications:

  • 1+ years of experience with Collections/Billing or Payor equivalent
  • Data analytics background
  • Strong understanding of rules and guidelines for Government and/or Non-Government Payors
  • Understanding of State and Federal Insurance laws and the various appeals processes including but not limited to Insurance Commission filings
  • Working knowledge of insurance carriers’ billing regulations and requirements including claims submission, claims follow-up, appeals process, and focused review processes

Telecommuting Requirements:

  • Ability to keep all company sensitive documents secure (if applicable)
  • Required to have a dedicated work area established that is separated from other living areas and provides information privacy
  • Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service

Soft Skills:

  • Excellent organizational and time management skills
  • Effective verbal and written English communication skills
  • Excellent interpersonal communications skills and ability to work with all levels of staff.

UnitedHealth Group requires all new hires and employees to report their COVID-19 vaccination status.

Military & Veterans find your next mission: We know your background and experience is different and we like that. UnitedHealth Group values the skills, experience and dedication that serving in the military demands. In fact, many of the values defined in the service mirror what the UnitedHealth Group culture holds true: Integrity, Compassion, Relationships, Innovation and Performance. Whether you are looking to transition from active duty to a civilian career, or are an experienced veteran or spouse, we want to help guide your career journey. Learn more at https://uhg.hr/transitioning-military

Learn how Teresa, a Senior Quality Analyst, works with military veterans and ensures they receive the best benefits and experience possible. https://uhg.hr/vet

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

Colorado, Connecticut, Nevada or New York City Residents Only: The salary range for Colorado residents is $16.00 - $26.88. The salary range for Connecticut / Nevada / New York City residents is $16.83 - $29.66. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives

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.

#RPO #YELLOW

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