16 days old

Senior Recovery Resolution Representative - Healthcare Claims - Ontario, CA - 920945

Ontario, CA 91764
  • Job Code
    920945

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.(sm)

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The Senior Recovery / Resolution Representative handles information about patient services and how those services are paid by investigating and pursuing recoveries through contact with various parties. The representative audits claims data for payment accuracy, bills providers for claim overpayments, process and post recovery on claim, and ensures adherence to compliance policies.

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"Primary Responsibilities:

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  • Provide claims expertise support by reviewing, researching, investigating, negotiating, and resolving all types of claims from providers as well as recovery and resolution for health plans both commercial customers, and government entities
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  • Ensure adherence to state and federal compliance policies, reimbursement policies, and contract compliance
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  • Obtain all available data relevant to the investigation of potential claim overpayment
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  • Utilize auditing tools to identify and determine accuracy of claims payments (prospectively and retrospectively)
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  • Prepare/generate claims overpayment billing along with explanation of the reason for overpayment and mail it to the appropriate provider
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  • Pursue recoveries and process / code overpayment / refund check
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  • Verify the refund check or debit offset is properly applied to the appropriate claim in the applicable System
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  • Analyze, identify, and report claim overpayments and resolutions to the Management Team
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  • Communicate effectively with internal / external clients
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  • This candidate is expected to act as a Claims resource for others in the Revenue Recovery department
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  • Perform other duties as assigned
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Youll 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.

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Required Qualifications:

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  • High school diploma or GED
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  • 2+ years of healthcare claims auditing, analyzing data, recovery, and collections experience
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  • 1 year of customer service experience analyzing and solving customer problems
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  • Experience working in the healthcare industry
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  • Proficiency with computer and Windows PC applications
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  • If you need to enter a work site for any reason, you will be required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or similar UnitedHealth Group-approved symptom screener. When in a UnitedHealth Group building, employees are required to wear a mask in common areas. In addition, employees must comply with any state and local masking orders
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"Preferred Qualifications:

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  • Experience in claims recovery resolution
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  • Knowledge of healthcare coding practices
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  • Strong communication skills (both written and verbal)
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  • Experience with negotiations
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Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)

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North American Medical Management, California, Inc (NAMM California) partnered with OptumHealth in 2012. NAMM California and OptumHealth share a common goal of bringing patients, physicians, hospitals and payers closer together in the mission to increase the quality, efficiency and affordability of care. NAMM California is a part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system. NAMM California develops and managers provider networks, offering a full range of services to assist physicians and other providers in supporting patient care coordination and their managed care business operations. For over 18 years, NAMM California has been an innovator in health care with a track record for quality, financial stability, extraordinary services and integrated medical management programs. NAMM California is well positioned to continually invest in its infrastructure and systems for the benefit of its provider clients and to accommodate the impending changes that will come forth from healthcare reform.

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The NAMM California provider clients represent a network of almost 600 primary care physicians and over 3,000 specialists and work with the premier hospitals in their respective markets.

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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.

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

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Job Keywords: Claims Examiner, Healthcare Claims, Disputes, Resolution, AB1455, Provider, Appeals, Health Plans, Recovery, Collections, Ontario, CA, California

Categories

Posted: 2021-04-01 Expires: 2021-05-01

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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Senior Recovery Resolution Representative - Healthcare Claims - Ontario, CA - 920945

UnitedHealth Group
Ontario, CA 91764

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