Senior Recovery & Resolution Analyst (Remote Claims Review)

ISHE; Northern (KY); Hybrid; USD 33,000 - 59,000; Full time

Benefits offered by this job

Telecommuting from anywhere in the U.S

Comprehensive benefits package

401k contribution

Job summary

UnitedHealth Group seeks a Senior Recovery Resolution Analyst to determine the accuracy of provider claims by comparing to medical records, and to provide coding expertise in post-payment reviews in a telecommuting-friendly environment.

You will analyze CPT/HCPCS coding, adhere to state and federal guidelines, and manage a clinical caseload with quality and productivity standards while collaborating with teams across the organization.

Qualifications

• High School Diploma or GED.
• Certified Coder AHIMA or AAPC (CPC/CCS/CCS-P/RHIT/CPMA/RHIA/CDIP).
• 2+ years coding, medical record auditing and coding/billing experience.
• 1+ year working in a metric-driven, team environment.
• Intermediate medical record review experience.
• Intermediate health insurance terminology and regulations knowledge.
• Experience with Microsoft & Adobe applications.

Responsibilities

• Performs quality audits of clinical review cases for CPT/HCPCS and modifiers in a telecommuting environment.
• Determines accuracy of coding and payment recommendations for post-payment claims.
• Includes consultations, state/federal mandates, policy interpretation and clinical data.
• Determines appropriate level of service using E/M coding principles.
• Adheres to compliance, reimbursement, and contract policies.
• Identifies aberrant billing patterns and potential fraud indicators.
• Manages daily case reviews with quality, utilization and productivity targets.
• Provides clinical support to investigative and analytical areas.
• Participates in team and department meetings, works independently when needed.

Skills

Medical coding

Medical record auditing

Team collaboration

Regulatory guidelines

AHIMA/AAPC certs

Microsoft & Adobe tools

Education

Bachelor degree

Tools

Microsoft Office

Adobe Acrobat

Job description

UnitedHealth Group seeks a Senior Recovery Resolution Analyst to determine the accuracy of provider claims by comparing to medical records, and to provide coding expertise in post-payment reviews in a telecommuting-friendly environment.

You will analyze CPT/HCPCS coding, adhere to state and federal guidelines, and manage a clinical caseload with quality and productivity standards while collaborating with teams across the organization.