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.The Senior Auditor 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 Senior Auditor 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 Senior Auditor will input information into Optum audit workflow tools and the client's case tracking system. The Senior Auditor will act as a subject matter expert in identifying, communicating and recouping improper payments as deemed appropriate. Where applicable, the analyst will provide appeals and investigative support, as well as testimony. Primary Responsibilities: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.
Required Qualifications:High School Diploma / GEDAAPC or AHIMA Coding and / or Auditing Certification2+ years of experience auditing and monitoringExperience with Microsoft Excel including data entry, sorting, creating / modifying spreadsheets, VLOOKUP, and formulas25% travel - only in the State of MAPreferred Qualifications:Multiple coding and auditing certifications preferred1+ year of experience analyzing data and identifying cost saving opportunitiesKnowledge of Medicaid / Medicare Reimbursement MethodologiesMicrosoft Access (create and modify queries and reports)Experience working with State Medicaid programsKnowledge of claims processing systems (general knowledge in how claims are processed) and guidelines / processesExperience working with long-term services and supports provided by MedicaidPhysical Requirements and Work Environment:Frequent speaking, listening using a headset, sitting, use of hands / fingers across keyboard or mouse, handling other objects, long periods working at a computerService center environment with moderate noise level due to Representatives talking, computers, printers, and floor activityCareers 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: UHG, UnitedHealth Group, claims, Senior Auditor, Boston, Massachusetts, Medicaid, Medicare, claims processing, healthcare, AAPC or AHIMA coding
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.