Recovery Resolution Consultant

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.

Optum Insight is improving the flow of health data and information to create a more connected system. We remove friction and drive alignment between care providers and payers, and ultimately consumers. Our deep expertise in the industry and innovative technology empower us to help organizations reduce costs while improving risk management, quality and revenue growth. Ready to help us deliver results that improve lives? Join us to start Caring. Connecting. Growing together.

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.

Primary Responsibilities:

• 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

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
• 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

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

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). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $72,800 - $130,000 annually based on full-time employment. We comply with all minimum wage laws as applicable.

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.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.