Payment Integrity ACR Reviewer - National Remote

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

UMR, UnitedHealthcare's third-party administrator (TPA) solution, is the nation's largest TPA. When you work with UMR, what you do matters. It's that simple . . . and it's that rewarding.

In providing consumer - oriented health benefit plans to millions of people; our goal is to create higher quality care, lower costs and greater access to health care. Join us and you will be empowered to achieve new levels of excellence and make a profound and personal impact as you contribute to new innovations in a vital and complex system. Opportunities are endless for your career development and advancement within UMR due to our record-breaking growth.

Regardless of your role at UMR, the support you feel all around you will enable you to do what you do with energy, quality, and confidence. So, take the first step in what is sure to be a fast - paced and highly diversified career.

The Enhanced Claim Analysis Reviewer completes high dollar facility claim itemized bill reviews for potential billing and coding errors. Their reviews typically result in unbundling denials, DRG down-coding, emergency room down-coding, unsupported denials, and more. They use multiple systems for the reviews including EncoderPro, Aerial, OnBase Documents, Alchemy, and CPS for claim history. Once the review is complete, the reviewer creates detailed denial rationales with policy references for the denials. They may assist with questions pertaining to coding denials when a provider submits a dispute and/or requests additional information regarding the specifics around the denials. We are looking for someone who is clear and concise and may be able to present these denials both internally and externally to providers and UMR senior leaders. The denial presentations include supporting evidence within the medical records and medical coding guidelines to educate providers on appropriate billing practices. This position is self-paced, where inventory is worked independently. A reviewer may assist analysts in searching for medical records, converting itemized bills, and editing dispute letters. Reviewers are involved in educational opportunities to maintain their CEU's needed to keep their certification current. The reviewers share their learning experiences with the team to enhance the team development, in addition to their own.

This position is full - time (40 hours / week), Monday - Friday. Employees are required to work any 5x 8-hour shifts between the hours of 7:00 AM - 5:00 PM (based on candidate's time zone) including the flexibility to work occasional overtime (some during peak season but not required) and flexible schedules based on business need.

The training for this position is on the job during your normally scheduled shift, which would be an 8-hour shift between 7:00 AM - 5:00 PM (based on candidate's time zone). Training will be conducted virtually from your home.

*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.

Primary Responsibilities:

• Perform coding reviews and provide claim and data analysis through a customized payment integrity reporting tool
• Review resources and research opportunities to expand areas of focus and develop new coding review criteria
• Work with internal and external partners to maintain and expand the fraud, waste, abuse and error edits to target additional claim types for review
• Complete assigned investigations by reviewing medical documentation and preparing informative reports which include documenting evidence
• Attend calls and meetings to present findings and supporting documentation to senior leadership and/or providers, explaining review processes and supporting policies of applied denials.
• Handle emails in a timely manner, providing professional and thorough responses to providers, internal and external partners, and leadership.
• Perform other duties as assigned
• Act as a resource for others

This is a challenging role with serious impact. You'll be providing a senior level of support and subject matter expertise within a fast paced, intense and high-volume claims operation where accuracy and quality are essential.

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 OR equivalent work experience
• 2+ years of experience with analyzing and solving customer problems in an office setting
• Medical coding certification OR the ability to obtain medical coding certification within 6 months of hire
• Experience with ICD-10 CM and PCS coding
• Moderate proficiency with computer and Windows PC applications, which includes the ability to navigate and learn new and complex computer system applications
• Intermediate level of Microsoft Excel (data entry, sorting, filtering, and pivot tables in spreadsheets)
• Must have experience working with GEHA members
• Must be 18 years of age OR older
• Ability to work any 8-hour shift between the hours of 7:00 AM - 5:00 PM (candidate's time zone)

Preferred Qualifications:

• 1+ years of experience processing medical claims in UMR CPS, including experience with complex claim processing and adjustments
• 1+ years of experience analyzing and solving customer problems
• Experience supporting projects

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:

• Ability to balance daily responsibilities independently while prioritizing escalated tasks
• Clear and concise written and verbal communication skills, including the ability to present during meetings

California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Washington, Rhode Island, OR Washington, D.C. Residents Only: The hourly range for this is $28.03 - $54.95 per hour. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. 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.

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.

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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