Senior Claims Quality Analyst – Tampa FL

Optum FL is seeking a Senior Claims Quality Analyst to join our team in Tampa FL. Optum is a clinician-led care organization that is changing the way clinicians work and live.

As a member of the Optum Care Delivery team, you’ll be an integral part of our vision to make healthcare better for everyone.

At Optum, you’ll have the clinical resources, data and support of a global organization behind you so you can help your patients live healthier lives. Here, you’ll work alongside talented peers in a collaborative environment that is guided by diversity and inclusion while driving towards the Quadruple Aim. We believe you deserve an exceptional career, and will empower you to live your best life at work and at home. Experience the fulfillment of advancing the health of your community with the excitement of contributing new practice ideas and initiatives that could help improve care for millions of patients across the country. Because together, we have the power to make health care better for everyone. Join us and discover how rewarding medicine can be while Caring. Connecting. Growing together.

Positions in this family support claim processing functions including investigations, negotiating settlements, payments, research regarding eligibility, etc.

This position is full-time (40 hours/week) Monday – Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 7:00am-7:00pm EST. It may be necessary, given the business need, to work occasional overtime. Employees are required to work some days onsite and some days from home.

We offer 4 weeks of on-the-job training. The hours of training will be aligned with your schedule which is Monday -Friday between 8am – 5pm.

If you are within commutable distance to the office at 5130 SUNFOREST DR Tampa, FL, you will have the flexibility to work from home and the office in this hybrid role* as you take on some tough challenges.

 

Primary Responsibilities:

• Reviews claims for data entry accuracy.
• Understands, interprets, and applies business policies and procedures related to claims, auditing, and data entry.
• Analyzes data to identify error trends and reports results.
• Maintains current knowledge of CMS and HIPPA regulations.
• Complies with deadlines to ensure audit cycles are completed and reported timely.
• Performs all other related duties as assigned.
• Demonstrate working knowledge of how to utilize and navigate applicable claims processing system used internal database.
• Identify and interpret applicable provider contract information.
• Serve on applicable cross-organizational quality committees/work groups to identify/ communicate common claims quality issues, trends, and patterns.
• Achieve production quality goals/metrics (e.g., audits per hour, audit accuracy, first-pass accuracy, rebuttal accuracy)
• Prioritizes and organizes own work to meet deadlines.
• Perform queries on relevant claims systems in order to obtain relevant information for audits.
• Validate claims data against information from claims processing systems to ensure that data is accurate.
• Analyze claims data against applicable policies and regulations to identify potential issues (e.g., member benefits, provider contracts, billing anomalies, payment accuracy, claims processing system issues, state mandates)
• Review history of related claims to pull in and understand additional claims-related information.
• Maintain reporting infrastructure, as appropriate (e.g., SharePoint, Access databases)
• Calculate dollar amount of financial claim errors/defects.

 

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

• High School Diploma or GED
• 18 years old or above
• 1 + years of claims or audit experience
• Medical terminology, 10-key, and computer literacy.
• Proficient with CMS 1500 and UB92 claim forms.
• Exceptional ability to organize, prioritize and communicate effectively.
• Must have commonly used knowledge of claims examination concepts, practices and rules, ICD, CPT and DRG coding.
• Utilize experience, knowledge, and judgment to plan, accomplish goals and effectively solve problems.
• Performs a variety of tasks that may require a limited degree of creativity and latitude
• Ability to work any of our shift scheduled during our normal business hours of 7:00am – 7:00pm from Monday – Friday

 

Preferred Qualifications:

• Microsoft Word and Excel skills 
• Strong knowledge of Medicare, Medicate and Manager Care

 

Telecommuting Requirements:

• Reside within commutable distance to the office at FL478 – FL478 – TAMPA-5130 SUNFOREST DR
• Ability to keep all company sensitive documents secure (if applicable)
• Required to have a dedicated work area established that is separated from other living areas and provides information privacy. 
• Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service.

 

Soft Skills:

• Good verbal and written communication skills
• Analytical and critical thinking skills
• Able to manage changing priorities and directives.
• Ability to work under time constraints.

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

 

The hourly range for this role is $28.61 to $56.06 per hour based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

 

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.

 

 

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.

 

#RPO