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Job Details


UnitedHealth Group

OptumCare Coordination of Benefits Subrogation -Telecommute

Healthcare

Director of Nursing

Yearly

No

Los Angeles, California, United States

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.(sm)

The health care system is still evolving at a rapid pace. Technology is driving new advances in how patient care is delivered and how it's reimbursed. Now, UnitedHealth Group invites you to help us build a more accurate and precise approach to claims adjudication. As part of our Recovery and Resolutions team, you'll provide consultative support to our business units and external vendor organizations. You'll handle requests, define business requirements and coordinate resolutions incorporating State/Federal regulations. Join us and build your career with an industry leader.

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

Primary Responsibilities:

  • Provide support for implementation and management of Payment Integrity Programs
  • Perform comprehensive research and identify billing abnormalities, questionable billing practices, and/or irregularities
  • Manage research and analyses of claims data to determine details of fraudulent or abusive billing activity
  • Have oversight of audits of provider records, clinical records, and itemized bills to ensure appropriateness of billing practices
  • Adapt departmental plans and priorities to address business and operational challenges
  • Influence or provide input to forecasting and planning activities
  • Provide support for Data Mining and Coordination of Benefit (COB) programs
  • Ability to research COB and Data Mining claims to determine validity
  • Able to manipulate and review large data sets

This is a challenging role with serious impact. You'll be assisting, educating, problem-solving and resolving challenging situations to the best possible outcomes. You'll need to understand and interpret clients' needs and ensure service and delivery excellence supporting the Fraud, Waste, Abuse, and Error product suite. This involves working with a high complexity solution set and cross functional teams to proactively review, research and resolve highly escalated inquiries.

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:

  • Bachelor’s degree or equivalent work experience
  • 3+ years of experience in the health care industry, in auditing, claims processing, payment integrity, claims configuration
  • 2+ years of experience conducting or managing comprehensive research to identify billing abnormalities, questionable billing practices, irregularities, and fraudulent or abusive billing activity
  • Proficiency in performing financial analysis/audit including statistical calculation and interpretation
  • Proficiency using Microsoft Word, Excel, PowerPoint, and Visio
  • Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation

Preferred Qualifications:

  • Undergraduate degree
  • 1+ of the following certifications: CPC, CPCO, AHFI, HCAFA, CFE
  • 1+ years of experience using claims platforms such as Facets, IDX, Xcelys, etc.
  • Experience working with federal contracts
  • Experience with Payment Integrity suite of programs
  • Experience launching new healthcare initiatives/ plan
  • Experience interpreting provider contractual agreements
  • Proficiency in various claims payment methodologies; to include capitation, fee-for-service, DRG, percent-of-charge, and OPPS
  • Proven ability to influence with and without direct management/authority
  • Demonstrated ability to support innovation and work in a changing environment
  • Proven excellent customer/consultant relationship and collaboration skills that influence successful outcomes
  • Demonstrated ability to manage time effectively while meeting expectations of stakeholders and business needs

To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment

Careers with Optum. Here's the idea. We built an entire organization 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, 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)

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

Colorado, Connecticut or Nevada Residents Only: The hourly range for Colorado residents is $26.15 to $46.63. The hourly range for Connecticut/Nevada residents is $28.85 to $51.30. 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.

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