ROI Analyst

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.

Process Overview:

Health Information Management (HIM) and Release of Information (ROI) functions are essential to maintaining the integrity, accessibility, and confidentiality of patient health records across healthcare organizations. These teams ensure that medical documentation is complete, accurate, and compliant with regulatory standards, supporting both clinical operations and patient care

The HIM team is responsible for managing health records, conducting chart analysis, tracking documentation deficiencies, and coordinating with stakeholders to resolve discrepancies. The ROI team handles the secure and compliant processing of medical record requests from providers, legal entities, and payers, in accordance with HIPAA and other applicable regulations for continuity of care.

Primary Responsibilities:

• Ability to read and comprehend healthcare terminologies
• Review patient medical records for completeness, accuracy, and consistency. E.g. H&P, Discharge Summary, Progress Note e.t.c
• The team's responsibility is to identify missing, conflicting, or unclear documentation and generate deficiencies, when applicable, to ensure timely physician completion and document release
• Teams receive log and track incoming requests for medical records
  • Complete the day-to-day activities in the Release of Information (ROI) area related to the access and disclosure of personal health information to the requestor
• Work on the Insurance denials and share the related Medical Records with the Insurance Company
  • Maintain HIPAA compliance by protecting the confidentiality, integrity, and security of patient health information
  • Responsible for meeting production, accuracy, and utilization targets while adhering to company policies, client guidelines, and professional conduct standards
• 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 regard 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:

• Bachelor's degree (preferably in life science) or equivalent
• 3+ years in US healthcare
• Solid knowledge of RCM, HIPAA, UB04 & HCFA 1500 and Medical Terminologies
• Proficiency in MS Office tools including Excel, Word, and Forms
• Open to work from office as per business requirements

Preferred Qualifications:

• Applications Experience: Cerner, eFR and Powerchart

Soft Skills:

• Ability to multi-task
• Excellent Communication and Time Management
• Problem solving, Critical Thinking, Organizational and Analytical skills
• Active listening skills
• Team building

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.