Senior Remote Claims Recovery Analyst

UnitedHealth Group; Minnesota; On-site; Confidential; Full time

Benefits offered by this job

Telecommute from anywhere in the U.S.

Benefits package

Job summary

Senior Recovery Resolution Analyst at UnitedHealth Group will determine accuracy of provider-submitted claims by comparing to medical records. You’ll review post-payment claims, interpret mandates, and provide written communications to providers. This role supports national clients and requires independent decision-making in a production-driven setting.

You’ll telecommute from anywhere in the U.S. with a focus on quality audits, coding accuracy, and adherence to regulatory guidelines while

Qualifications

• High School Diploma or GED.
• 2+ years of coding experience with medical record auditing and coding/billing.
• 1+ years in a metric-driven, team environment with daily production standards.
• Intermediate experience with health insurance business, terminology, and regulatory guidelines.
• Proficient with Microsoft & Adobe applications.

Responsibilities

• Perform quality audits of clinical review cases and determine coding/billing accuracy.
• Assess post-payment claims with medical record/documentation review.
• Interpret state and federal mandates, policies and clinical information for reviews.
• Determine appropriate level of service using E/M coding principles.
• Identify aberrant billing patterns and potential fraud, waste or abuse.
• Manage daily case reviews with quality, utilization and productivity guidelines.
• Collaborate with partners and provide clinical support when needed.
• Engage in team and department meetings and work independently when appropriate.

Skills

Analytical mindset

Communication skills

Independent worker

Tech-savvy

Education

Bachelor degree

AHIMA/AAPC Certification

Tools

COSMOS

Facets

CPW

NICE

Job description

Senior Recovery Resolution Analyst at UnitedHealth Group will determine accuracy of provider-submitted claims by comparing to medical records. You’ll review post-payment claims, interpret mandates, and provide written communications to providers. This role supports national clients and requires independent decision-making in a production-driven setting.

You’ll telecommute from anywhere in the U.S. with a focus on quality audits, coding accuracy, and adherence to regulatory guidelines while