Senior Recovery Resolution Analyst
About The Position
This position is 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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together. The Senior Recovery / Resolution Analyst will work with a team on researching issues to determine feasibility of reducing medical costs through prospective solutions of claim system processes and claim business rules. This position is full-time, Monday - Friday. Employees are required to work our normal business hours of 8:00am - 5:00pm. It may be necessary, given the business need, to work occasional overtime or weekends. We offer on-the-job training. The hours of the training will be aligned with your schedule.
Requirements
- High School Diploma / GED
- Active Certified Professional Coder (CPC) credential
- Must be 18 years of age OR older
- 2+ years of experience with claims auditing and researching claims information
- 1+ years of coding experience
- Knowledge of claims processing systems and guidelines/processes
- Experience in healthcare setting
- Ability to work full-time, Monday - Friday. Employees are required to work our normal business hours of 8:00am - 5:00pm. It may be necessary, given the business need, to work occasional overtime or weekends
Nice To Haves
- Coding Certification (CCS or CPMA)
- 1+ years of experience analyzing data and identifying cost saving opportunities
- Knowledge of Medicaid / Medicare Reimbursement methodologies
- Experience with Microsoft Access (create, edit, format, manipulate data)
- Experience with OPRS (claims processing system)
- Experience working with medical claims platforms
- Experience with Microsoft Excel (create, edit, sort, filter)
Responsibilities
- Examine, assess, and document business operations and procedures to ensure data integrity, data security and process optimization
- Investigate, recover, and resolve all types of claims as well as recovery and resolution for health plans, commercial customers, and government entities
- Investigate and pursue recoveries and payables on subrogation claims and file management
- Process payment on claims
- Ensure adherence to state and federal compliance policies, reimbursement policies, and contract compliance
- Use pertinent data and facts to identify and solve a range of problems within area of expertise
Benefits
- In addition to your salary, we offer 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 us, you'll find a far-reaching choice of benefits and incentives.
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What This Job Offers
Job Type
Full-time
Career Level
Senior
Education Level
High school or GED
Number of Employees
5,001-10,000 employees
