Recovery Resolution Consultant – National Remote

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 diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

As the Recovery Resolution Consultant, you will be a key member of the Optum Care Payment Integrity team, supporting our clinical/coding operations team. The OCPI Premium Audit Services team is a key partner for all value streams across Payment Integrity. We develop a deep understanding of the business operations and associated data, to establish KPI’s, reporting, and analysis, and to measure performance and drive continuous improvement.

This position is full-time. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 7:00am – 4:00pm CST. It may be necessary, given the business need, to work occasional overtime.

We offer weeks of on-the-job training. The hours of training will be aligned with your schedule or will be discussed on your first day of employment.

You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

             

Primary Responsibilities:

• Analyze, review, and perform root cause analysis on complex operational claims data
• Present analysis and recommendations for operational and business review/planning
• Support short and long-term operational/strategic business activities through analysis
• Develop, recommend, and implement business solutions through research and analysis of data and business processes
• Responsible for guidance related to Payment Integrity initiatives to include concept and cost avoidance development
• Identifies trends and patterns with overall program and individual provider coding practices
• Supports the creation and execution of strategies that determine impact of opportunity and recover overpayments as well as prospective internal controls preventing future overpayments of each applicable opportunity

            

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 / GED OR equivalent work experience
• Coding Certification with one of the following:  CPC, CCS-P, RHIA, RHIT, etc.
• Must be 18 years of age OR older
• 5+ years of experience in the health insurance industry
• 3+ years of Business Analysis experience, specifically with operational support
• 3+ years of experience with health insurance claims
• 2+ years of experience within Payment Integrity
• Proficiency using Microsoft Word
• Proficiency using Microsoft Excel (data analysis, sorting/filtering, pivot tables)
• Proficiency using Microsoft PowerPoint (prepare formal presentations and training)
• Proficiency using Microsoft Visio (develop workflow processes)
• Ability to work full-time, in any of our 8-hour shift schedules during our normal business hours of 7:00am – 4:00pm CST, including the flexibility to work occasional overtime, based on the business need

       

Preferred Qualifications:

• Experience performing root cause analysis
• Experience coding in a multi-specialty physician clinic
• Facet claims system experience

      

Telecommuting Requirements:

• 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

          

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

         

The hourly range for this role is $85,000 annually 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.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

 

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.

 

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