Quality Auditor

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.

This is a full-time onsite role; candidates must be flexible to work from the office as required (hybrid work is not available)

Primary Responsibilities:

• Quality review for end-to-end RCM process. Especially Denial management and AR follow up audits
• Communicates with leadership for training when a knowledge gap is identified
• Acts upon leadership feedback of issues identified and develops action plan for solutions
• Supports QA solutions that serve the needs of operations in understanding review results and actions taken to resolve gaps in the process
• Collaborates with internal stakeholders with RCA findings and trends in process gaps and prepare suggestions basis CAPA to improve processes
• Acts as a resource to others on the team and department
• Utilizes critical thinking skills to solve for issues
• Performs Quality reviews to validate process accuracy and input findings into EQT
• Logs daily productivity into EQT
• Communicates issues/gaps identified while performing daily activities
• Completes other tasks as assigned
• Solves moderately complex issues
• Actively participates in meetings 
• Practices standard operating procedures, policies, and process knowledge of how they impact the business and operations
• Uses QA methodology when participating on projects that will improve the overall process for the department and operations
• Works with leader on potential solutions when issues are identified during QA review process
• Comply with the terms and conditions of the employment contract, company policies and procedures, and any and all directives (such as, but not limited to, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regards to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment). The Company may adopt, vary or rescind these policies and directives in its absolute discretion and without any limitation (implied or otherwise) on its ability to do so

Required Qualifications:

• Graduate education
• Experience working with hospital and physician claims
• 2+ years of experience in a role supporting a quality assurance function or related operational function within Revenue Cycle Management
• Knowledge in Revenue Cycle Management
• Experience in effective communications (verbal, written, and presentation) skills with the ability to communicate to a variety of management levels within the organization including leadership
• Intermediate MS Office experiences including Word, Excel, and PowerPoint
• Proven analytical skills that will lead to aiding in process improvements within the department and operations
• Demonstrates an understanding of the organizations’ operations, products and applications, strategies, processes, and/or business priorities for effective outcomes
• Proven ability to work independently and collaborate with team members across LPS
• Proven solid written and verbal communication skills
• Proven effective in using relevant computer systems and software (EQT, Reporting Systems, OLC, operations systems, MS Office)

Preferred Experience:

• Experience in large, multi-function and cross geographic organization
• Specific experience working in an Operations Environment
• Technical Tools: Understands relevant computer systems and software (i.e., Reporting Systems, Operations systems, MS Office)

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.

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