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.The Sr. Network AR Analyst is responsible for reviewing post-adjudicated, pre-payment facility and professional claims to identify aberrant coding and billing. Includes reviewing complex, forensic, or abusive billing of claims and related medical records and itemization bills. No ID-10 diagnosis experience required. This unique position includes detailed chart review, a strong knowledge of CPT/HCPCS coding and a drive to research the unknown.You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges.Primary Responsibilities:
Conducts clinical review of medical records and associated claims
Manages workload that meets or exceeds production and quality goals
Investigate, research and analyze claims data to determine details of fraudulent or abusive billing activity
Documents clinical review findings, maintaining thorough, objective, and consistent reviews
Interface with other teams, and indirectly with clients through correspondence to answer questions and resolve issues relative to review criteria
Participates in process and clinical review improvement activities
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:
RN license or related healthcare field
Certified Professional Coder (CPC) or Certified Outpatient Coder (COC); or will get certified within one year of employment
5+ years of healthcare industry, medical record/claim review/audit experience
2+ years CPT & HCPCS Coding experience
Knowledge of medical terminology
Preferred Qualifications:
Bachelor’s degree; Master’s degree
SIU experience Knowledge of claims process
Knowledge of genetic testing or laboratory billing
Computer skills: navigation through various Web based systems, ability to use email, Excel and Word
Proven self-motivated professional with attention to detail, having solid written and verbal communication skills
Working Condition/Physical Requirement:
General office demands
Travel:
None
All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter PolicyCalifornia, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Rhode Island, Washington or Washington, D.C. Residents Only: The salary range for this role is $58,300 to $114,300 annually. 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.