Position Description: You'll join a high caliber team where you're assisting, educating, problem-solving and resolving tenuous situations to the best possible outcomes. Bring your people skills, emotional strength and attention to detail. In return we offer the latest tools and most intensive training program in the industry. Get ready to start doing your life's best work.(sm)
The Audit & Recovery Investigator will be responsible for triaging, investigating and resolving instances of healthcare fraud and / or wasteful and abusive conduct by health care providers who submit claims for payment. This position will be utilizing information from claims data analysis, plan members, the medical community, law enforcement, employee conduct, and confidential investigations in order to document relevant findings. The investigator will conduct onsite and desk audits of provider claims and / or clinical audits (utilizing appropriate personnel) to gather and analyze all necessary information and documentation related to the investigation, and prepare all necessary reports. The investigator will input information into Optum audit workflow tools and the clients case tracking system. The investigator will act as a subject matter expert in identifying, communicating and recouping improper payments as deemed appropriate. Where applicable, the investigator will provide appeals and investigative support, as well as testimony.
Investigate, audit, and resolve all types of Medicaid claims as well as recovery and resolution for government payers
Process recovery 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
The successful candidate will be part of a group of auditors deployed to investigate possible fraud, waste and abuse in Massachusetts
Generally work is self-directed and not prescribed
Works with less structured, more complex issues
Serves as a resource to others and as a lead to analyst positions
UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.
We are committed to introducing innovative approaches, products and services that can improve personal health and promote healthier populations in local communities. Our core capabilities... in clinical care resources, information and technology uniquely enable us to meet the evolving needs of a changing health care environment as millions more Americans enter a structured system of health benefits and we help build a stronger, higher quality health system that is sustainable for the long term.
We serve our clients and consumers through two distinct platforms:
?UnitedHealthcare, which provides health care coverage and benefits services.
?Optum, which provides information and technology-enabled health services.