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 Senior Recovery/Resolution Analyst - Franklin, TN - Franklin, Tennessee, United States

   
Job information
Posted by: UnitedHealth Group 
Hiring entity type: Insurance 
Work authorization: Existing work authorization required for United States
Position type: Direct Hire, Full-Time 
Compensation: ******
Benefits: See below
Relocation: Not specified 
Position functions: Administrative - Other
Customer service & support
Insurance
 
Travel: Unspecified 
Accept candidates: from anywhere 
Languages: English - Fluent
 
Minimum education: See below 
Minimum years experience: See below 
Resumes accepted in: English
Cover letter: No cover letter requested
Job code: 519240 / Latpro-2478998 
Date posted: May-11-2013
State, Zip: Tennessee, 37064

Description

Position Description:

Flexible? Friendly? Fast on your feet? That's a great start. Accurate? Accountable? Self-Directed? These traits can take you places. Our claim data mining operations are the focal point of handling information about services patients receive and the way those services get paid. It's complex, detailed work. It's fast paced challenge. It's a job that calls on you to be thoughtful, resourceful, team-driven and customer-focused. To put it mildly, there is never a dull moment.

 

Positions in this function are responsible for investigating and resolving all types of claims for health plans, commercial customers and government entities. May include initiating telephone calls to providers and other insurance companies to gather patient service data. Ensure adherence to state and federal compliance policies, reimbursement policies and contract compliance. May monitor large claims including transplant cases.

 

Primary Responsibilities:

  • Investigate and resolve all types of claims for health plans, commercial customers, and government entities
  • Initiate phone calls to providers, and other insurance companies to gather claim information
  • Ensure adherence to state and federal compliance policies, reimbursement policies, and contract compliance
  • Generally work is self-directed and not prescribed.
  • Works with less structured, more complex issues.
  • Serves as a resource to others.
  • Work with team members to ensure project goals are met in an efficient and effective manner
  • Achievement of individual productivity and quality standards
  • Give feedback to Management regarding query effectiveness and new query ideas
  • Coordinate with other departments to enhance query effectiveness and develop new query ideas




Requirements

Requirements:
  • High School diploma/GED required
  • 5+ years’ healthcare experience in a claims processing area or in a provider billing OR 2+ years’ experience and a Bachelor’s degree.
  • Work Shift - Monday thru Friday 8 AM to 5 PM
  •  Intermediate Word and Excel required (Word – creating documents; Excel – creating and generating new reports.  Filtering, sorting and graphing)

Assets:

  • 3+ years Claims auditing/research experience (Should have claims expertise and knowledge to a degree that they can recognize inconsistency and data integrity issues)
  • Previous contracting experience in a role such as Provider Contracting, Provider Service, or Claims QA
  • Experience with Prior Authorization or Medical Reviews


OptumInsight 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.

OptumInsight is one of the largest and fastest growing health information companies. We specialize in improving the performance of the health system by providing analytics, technology and consulting services that enable better decisions and results. We integrate workflow solutions that deliver data in real-time, and create actionable insights - processing health information that relates directly to and affects one in four patients in the U.S., one in every three Medicaid dollars and one in every five emergency room visits. And we do it all with every action focused on our shared values of Integrity, Compassion, Relationships, Innovation & Performance.

What can YOU do with the right information? At OptumInsight, the possibilities and the impact are limitless. No matter what your role is at OptumInsight, you'll be empowered to ask more questions, develop better solutions and help make the health care system greater than ever. It's always fresh. It's always exciting. And it's never been more important.

Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.


 

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