Post Audit Program Coordinator - National Remote | Optum

You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

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.

Do you have experience building relationships with providers? Experience working in Fraud, Waste, Abuse, & Error? Are you a hotshot Microsoft Excel user? Want to work with an elite team of some of the brightest and most inventive people in the healthcare & technology industries? Optum is a health services business, part of the UnitedHealth Group family of companies, dedicated to making the health system work better for everyone. We serve people throughout the entire health system. Our team enjoys conversation-changing, life-changing, world-changing opportunities throughout their careers. Join us and see what it’s like to do your lifes best work.

Post Audit Program Coordinator will be responsible for creating and preparing findings letters and appeal determination letters, assessing value of claims, and conducting provider follow ups to obtain signoff. This position supports the review of suspected waste & abuse of health insurance claims.

This position is full-time (40 hours/week) Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8am - 5pm EST, must be on phones 1-5p EST. It may be necessary, given the business need, to work occasional overtime.

We offer weeks of paid training. The hours of the training will be based on schedule or will be discussed on your first day of employment.

• All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

Primary Responsibilities:

• Analyze large spreadsheet of data
• Use sound judgment and decision-making skills to assess value and determine appropriate list of claims/patients that require signoff
• Acts as the central point-of-contact for specific hospital and health systems regarding the post audit process
• Plays a pivotal role in building relationships and influencing providers to obtain signoff on audits
• Accountable for day-to-day tasks associated with claims, including sending audit findings and appeal determination responses and following up with providers to obtain signoff
• Ensure adherence to federal compliance policies, contract compliance
• Collaboration with Clinical/Appeals Investigator, Legal and Compliance for claim review

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
• Intermediate or better proficiency with Microsoft Word (create, edit and format)
• Intermediate or better proficiency with Microsoft Excel (create, edit and format and pivot table experience)
• 1+ years of claims experience
• Must be 18 years of age or older
• Ability to work full-time (40 hours/week) Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8am - 5pm EST, must be on phones 1-5p EST. It may be necessary, given the business need, to work occasional overtime.

Preferred Qualifications:

• 2+ years of health insurance experience
• Knowledge of FWAE or Payment Integrity

Soft Skills:

• Strong written, verbal, analytical, organizational, time management, and problem-solving skills
• Strong interpersonal skills with ability to quickly build relationships
• Ability to adapt in a dynamic and high-growth environment
• Self-motivated with the ability to work independently
• Demonstrated adaptability and savvy in navigating a large, matrixed organization

California, Colorado, Connecticut, Nevada, New Jersey, New York, Washington or Rhode Island Residents Only: The hourly range for California / Colorado / Connecticut / Nevada / New York / New Jersey / Washington / Rhode Island residents is $22.45 - $43.89 per hour. Pay is based on several factors including but not limited to education, work experience, certifications, etc. 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.

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.

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