Recovery Resolution Analyst – National Remote

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

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

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 8:00 AM – 5:00 PM. It may be necessary, given the business need, to work occasional overtime.

We offer 4 weeks of paid training. The hours of training will be based on your schedule during normal business hours or will be discussed on your first day of employment. Training will be conducted virtually from your home.

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

Primary Responsibilities:

• Analyzes and investigates Behavioral Health medical records received from providers being audited.
• Medical records are matched up to pended claims and sent to the pre – pay coding department for clinical review.
• Provides explanations and interpretations within area of expertise.
• Positions in this function are responsible for investigating, preventing payment and resolving all types of claims as they relate to Behavioral Health fraud and abuse.
• Ensure adherence to state and federal compliance policies, reimbursement policies, and contract compliance.
• May conduct contestable investigations to review medical history.

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
• 2+ years of medical claims experience with analyzing and researching
• Experience with using one (1) OR more of the following claims platforms COSMOS, UNET, FACETS, or USP / CIRRUS with the ability to conduct research in the platforms
• Basic proficiency with computers and Windows PC applications
• Basic proficiency with Microsoft Word, Microsoft Excel, and Microsoft Outlook
• Ability to work any 8-hour shift between the hours of 8:00 AM – 5:00 PM including the flexibility to work occasional overtime based on business need
• Must be 18 years of age OR older

Preferred Qualifications:

• 3+ years of experience with working in a FWA OR Fraud investigations role
• Claims processing OR adjusting experience
• Experience with working in the Behavioral Health

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

California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Washington, or Rhode Island Residents Only: The hourly range for this is $23.22 – $45.43 per hour. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. 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.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location, and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.

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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