Position Description:Welcome to one of the toughest and most fulfilling ways to help people, including yourself. We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement. Join us and start doing your life's best work.Optum is part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system.If you get excited about the life transforming potential of bringing health care information to the right place, at the right time, to support crucial decisions, welcome to Optum.We're one of the largest and fastest growing health information companies and the only organization in our industry with the information, technology and consulting expertise to solve the most significant challenges in health and human services.As a vital member of the UnitedHealth Group family, we serve customers in every segment of the health care field. This includes government agencies, pharmaceutical companies, hospitals and health delivery networks, insurance providers and, of course, the diverse business divisions of UnitedHealth Group.Bring your talent to an industry leader with the information, technology, and consulting expertise to help transform health and human services. No matter what your role, you'll be empowered to ask more questions, develop better solutions and help make the health care system greater than ever.Positions in this function are responsible for investigating, recovering and resolving all types of claims as well as recovery and resolution for health plans, commercial customers and government entities. Position will include providing support for incoming provider calls and initiating telephone calls to providers to gather medical claims documentation. Investigate, pursue and process recovery on claims. Ensure adherence to state and federal compliance policies, reimbursement policies and contract compliance. May conduct contestable investigations to review medical history. Primary Responsibilities:Handle incoming / outgoing calls, faxes and mail from healthcare providersMonitor and manage call and review case load, ensuring expedient review resolutionCompile documentation and review for accuracy and completenessData entry for all calls, documentation, and review outcomesParticipate in all meetings and training sessionsManages assigned projectsAttend onsite reviewsAttend and / or participates in hearingsActively identifies and shares best practicesReview provider disputes, summarize specifics of review results
Required Qualifications:High School Diploma / GED (or higher)1+ years of experience auditing and monitoring casesCertified Professional Coder (CPC) Experience with Microsoft Excel including data entry, sorting, creating / modifying spreadsheetsPreferred Qualifications:2+ years of medical claims coding / medical terminology / processing experience Multiple coding and auditing certifications CIC (Certified Inpatient Coder) CertificationCOC (Certified Out Patient Coder) CertificationCPMA (Certified Professional Medical Auditor) CertificationKnowledge of Medicaid / Medicare Reimbursement MethodologiesSoft Skills:Advanced communication (verbal and written) and analytical skillsCareers 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: Senior Recovery Resolutions Analyst, Portland, Maine, Claims, Medical claims, coding, CPC, Medicaid, Medicare, Commercial Insurance Entities, UnitedHealth Group, Optum
Our mission is to help people live healthier lives and to help make the health system work better for everyone.- We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities. - We work with health care professionals and other key partners to expand access to quality health care so people get the care they need... at an affordable price. - We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions.