[Hiring] Recovery Resolution Consultant @UnitedHealth Group

Role Description

This position is National Remote. You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges. This position is full-time Monday - Friday. Employees are required to have flexibility to work any of our shift schedules during our normal business hours of 8am - 5pm. This will be on the job training and the hours during training will be during normal business hours.

• Provide assistance, give feedback, and request action in completing daily and monthly reporting, i.e. (Quality, Automation, Platforms)
• Aid in writing and implementing process improvement ideas, processes, i.e., Process mapping, job aids, PNP (Policies and Procedures)
• Create and present on-going development and educational training for production staff
• Aid with daily inventory management, task assignment and ensure escalations are responded to timely
• Be responsible for responding to complex coding case related questions placed on the SME/MD portal
• Responsible for supporting quality metric activities, including but not limited to the monthly questions for Quality Knowledge Test, enrollment and attend meetings as required
• Provide detailed research on claims and complex coding cases that require research
• Provide feedback/support for client and/or senior leadership meetings/presentations that include gathering key data/information and updating of forms/materials
• Work with OGA and OPRO teams to ensure consistent processes and claim resolution
• Assist internal teams with subject matter expertise such as appeals, QA, Second Set of Eyes, True Positive Rate Re-review, training, Root Cause, Clinical Program Optimization, Issue Resolution, PIRT and provider escalation teams
• Be point of contact and perform administrative duties when the manager is out
• Be available for questions via team chats and/or emails, provide coaching when employees need additional support
• Own and be accountable in the creation, development, and upkeep of Clinical team job aids to ensure the information is consistent and up to date
• Responsible for creating and facilitating bi-weekly team huddles agenda topics and education
• Participate in overarching organizations meetings i.e. (Town Halls, Manager meetings, Monthly Leadership Connect, leader Link Series)
• Attend and provide feedback for meetings that impact business operations, i.e. (Management of Change, Work Force Management, Automations, Projects, Change Advisory Board, R&D/Ideation)
• Other duties/Projects as assigned by leadership

Qualifications

• High School Diploma / GED
• Certified Coder AHIMA OR AAPC Certified coder (CPC, CCS, CCA,)
• Must be 18 years of age OR older
• 2+ years of experience as an AHIMA or AAPC Certified coder
• Understanding of Fraud, Waste, Abuse and Error principles and health insurance experience
• Knowledge of health insurance business, industry terminology, and regulatory guidelines
• Experience leading projects, initiatives, or team members, including mentoring, coaching, training, or serving in a team lead capacity
• Ability to work full-time Monday - Friday. Employees are required to have flexibility to work any of our shift schedules during our normal business hours of 8am - 5pm

Preferred Qualifications

• 2+ years of Fraud, Waste, Abuse and Error Clinical Appeals/Reconsiderations team and process experience
• 1+ years of experience of UHC platforms (COSMOS, Facets and CPW and / or working with medical terminology or coding) and/or other adjudication platforms
• Healthcare claims experience
• Investigational and / or medical auditor auditing experience, including government and state agency auditing
• Experience with Payment Integrity (Optum)
• Experience with Microsoft Word (create correspondence and work within templates), Microsoft Excel (data entry, sort / filter, and work within tables) and Microsoft Outlook (email and calendar management)

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

Soft Skills

• Highly organized with effective and persuasive communication skills
• Strong, analytical, problem-solving and decision-making skills; ability to exercise good judgment
• Exceptional telephone and client service skills; ability to interact professionally in challenging situations
• Open to change and new information; ability to adapt in changing environments and integrate best practices
• Desire to move into a leadership role
• Strong communication skills with the ability to interpret data

Pay and Benefits

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary for this role will range from $72,800 - $130,000 annually based on full-time employment.

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.