Senior Recovery Resolution Analyst - MA Long Term Services and Supports

UnitedHealth Group•Boston, MA

1d•$29 - $52•Remote

About The Position

This position is Remote in Massachusetts, offering flexibility to work remotely while tackling challenging tasks. Optum Insight aims to improve the flow of health data and information to create a more connected system, reducing friction and driving alignment between care providers, payers, and consumers. The Senior Recovery Resolution Analyst will be responsible for performing compliance reviews of medical and administrative documentation to identify instances of healthcare fraud, wasteful, and abusive conduct by health care providers. This role involves utilizing information from claims data analysis, plan members, the medical community, law enforcement, employee conduct, and confidential investigations to document findings. The Sr. Recovery Resolution Analyst will conduct site visits and desk audits of provider claims, medical, and administrative records to gather and analyze information, ensuring adherence to state and federal compliance policies, reimbursement policies, and contract compliance. The analyst will present audit findings to clients, input information into Optum audit workflow tools and the client’s case tracking system, and support appeal and fraud investigation activities where applicable.

Requirements

Nurse licensure (RN or LPN) with a current, active, and unrestricted license in Massachusetts
Must have a Valid Driver’s license
2+ years of experience reviewing health care documentation in a clinical or administrative role
Experience with MS Office Suite, specifically Word, PowerPoint, and Excel (including familiarity with basic formulas and data analysis)
Must be willing to travel up to 25% within the state of Massachusetts as business needs dictate
Ability to work full-time (40 hours/week), Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of Monday thru Friday 8:00 am – 5:00 pm local time. It may be necessary, given the business need, to work occasional overtime
Must reside in the state of Massachusetts
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
All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

Nice To Haves

Clinical or administrative experience in long term care, for example, nursing facility care delivery/administration and/or community-based LTC service programs like Home Health
Experience in claim processing, healthcare provider information, and healthcare billing practices
Experience working in a remote/telecommute workspace
Familiarity with Medicaid program and/or billing requirements
Working knowledge of medical terminology and claim coding with familiarity of CPT-4, HCPCs and ICD-10 code terminology

Responsibilities

Review medical and administrative records for audit/compliance review
Travel to provider sites up to 25%/month to collect records and engage with providers
Present and participate in discussions with the client regarding audit observations and findings
Collaborate with a team of 2-5 auditors to complete reviews
Enter audit findings data and notes in online/electronic platform using Excel-based templates
Attend and participate in dispute reviews and administrative hearings
Demonstrated written and verbal communications skills
Demonstrated customer service skills