Recovery / Resolutions Analyst - Eden Prairie, MN or US Telecommute

UnitedHealth Group
Aug 12, 2017
Aug 16, 2017
Employer Type
Direct Employer
Employment Type
Full Time
Position 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 17 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 and Performance.

The Recovery / Resolution Analyst handles information about patient services and how the services are paid by investigating and pursuing recoveries through contact with various parties. The representative manages subrogation files, negotiates settlements, and ensures adherence to compliance policies.

Primary Responsibilities:

* Perform investigation on tips / allegations to identify potential Fraud, Waste, Abuse, or Error (i.e. internet research, review claims history on various platforms and FWAE databases), based on applicable Job Aids
* Perform member and provider interviews, and review medical documentation as needed
* Document in a professional manner the investigation activities that were performed on tips and allegations
* Adjust claims as needed based on investigation performed
* Refer tip / allegation to the appropriate internal team
* Communicate with clients and business partners as needed
* Submit CMS reporting as required
* Ensure adherence to state and federal compliance policies and reimbursement policies
* Adhere to turn around time standards
* Meet and maintain minimum quality and productivity standards

Required Qualifications:

* Associate's Degree (or higher) or a High School Diploma / GED with 3+ years of insurance or fraud investigation experience
* 2+ years of Insurance experience with one or more of the following: Claim Processing, Provider Demographic Information or Insurance Billing Practices
* Ability to use Microsoft Excel (create pivot tables, and use spreadsheet for tracking)

Preferred Qualifications:

* 2+ years of experience in criminal justice, legal or fraud investigation
* Experience in working with claims platforms
* Professional Certification as a Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI), or similar
* Familiar with CPT code terminology

Soft Skills:

* Experience in solving complex problems by utilizing computer research
* Experience utilizing interpersonal skills: objective, collaborative approach
* Experience working independently with the ability to make decisions using critical thinking skills

Physical Requirements and Work Environment:

* Frequent speaking, listening using a headset, sitting, use of hands / fingers across keyboard or mouse, handling other objects, long periods working at a computer
* Service center environment with moderate noise level due to Representatives talking, computers, printers, and floor activity

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.

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, Certified Fraud Examiner (CFE), claims platforms, Claim Processing, Provider Demographic Information, Insurance Billing Practices

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