Recovery Resolution Consultant

UnitedHealth Group•Tampa, FL

1d•$72,800 - $130,000•Remote

About The Position

Optum Insight is improving the flow of health data and information to create a more connected system. We remove friction and drive alignment between care providers and payers, and ultimately consumers. Our deep expertise in the industry and innovative technology empower us to help organizations reduce costs while improving risk management, quality and revenue growth. Ready to help us deliver results that improve lives? Join us to start Caring. Connecting. Growing together.

Requirements

High School Diploma / GED
Certified Coder AHIMA OR AAPC Certified coder (CPC, CCS, CCA,)
Must be 18 years of age OR older
2+ years of experience as an AHIMA or AAPC Certified coder
Understanding of Fraud, Waste, Abuse and Error principles and health insurance experience
Knowledge of health insurance business, industry terminology, and regulatory guidelines
Experience leading projects, initiatives, or team members, including mentoring, coaching, training, or serving in a team lead capacity
Ability to work full-time Monday - Friday. Employees are required to have flexibility to work any of our shift schedules during our normal business hours of 8am - 5pm

Nice To Haves

2+ years of Fraud, Waste, Abuse and Error Clinical Appeals/Reconsiderations team and process experience
1+ years of experience of UHC platforms (COSMOS, Facets and CPW and / or working with medical terminology or coding) and/or other adjudication platforms
Healthcare claims experience
Investigational and / or medical auditor auditing experience, including government and state agency auditing
Experience with Payment Integrity (Optum)
Experience with Microsoft Word (create correspondence and work within templates), Microsoft Excel (data entry, sort / filter, and work within tables) and Microsoft Outlook (email and calendar management)

Responsibilities

Provide assistance, give feedback, and request action in completing daily and monthly reporting, i.e. (Quality, Automation, Platforms)
Aid in writing and implementing process improvement ideas, processes, i.e., Process mapping, job aids, PNP (Policies and Procedures)
Create and present on - going development and educational training for production staff
Aid with daily inventory management, task assignment and ensure escalations are responded to timely
Be responsible for responding to complex coding case related questions placed on the SME/MD portal
Responsible for supporting quality metric activities, including but not limited to the monthly questions for Quality Knowledge Test, enrollment and attend meetings as required
Provide detailed research on claims and complex coding cases that require research
Provide feedback/support for client and/or senior leadership meetings/presentations that include gathering key data/information and updating of forms/materials
Work with OGA and OPRO teams to ensure consistent processes and claim resolution
Assist internal teams with subject matter expertise such as appeals, QA, Second Set of Eyes, True Positive Rate Re-review, training, Root Cause, Clinical Program Optimization, Issue Resolution, PIRT and provider escalation teams
Be point of contact and perform administrative duties when the manager is out
Be available for questions via team chats and/or emails, provide coaching when employees need additional support
Own and be accountable in the creation, development, and upkeep of Clinical team job aids to ensure the information is consistent and up to date
Responsible for creating and facilitating bi-weekly team huddles agenda topics and education
Participate in overarching organizations meetings i.e. (Town Halls, Manager meetings, Monthly Leadership Connect, leader Link Series)
Attend and provide feedback for meetings that impact business operations, i.e. (Management of Change, Work Force Management, Automations, Projects, Change Advisory Board, R&D/Ideation)
Other duties/Projects as assigned by leadership