Opportunities at WellMed, part of the Optum Family
We believe all patients are entitled to the highest level of medical care. Join our team of passionate individuals dedicated to helping people achieve better health.
Remote Work Flexibility
You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:
- Takes ownership of the total work process and provides constructive information to minimize problems and increase customer satisfaction
- FWAE detection and identification of aberrant behavior for providers and facilities
- Investigate, review and provide clinical and/or coding expertise in review of post-service, pre-payment or post-payment claims
- Make pay/deny recommendation decisions based on findings; this could include Medical Director/physician consultations and working independently while making decisions
- Identify updated clinical analytics opportunities and participate in projects as necessary
- Maintain and manage case review assignments
- Ensure issues are identified, tracked, reported and resolved
- Escalate issues as needed for support and/or guidance
- Keep abreast of current Medicare guidelines and regulations by reviewing updates, bulletins and changes to CMS manuals
- Performs all other related duties as assigned
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 education or equivalent
- 2+ years of relevant experience
- Coding certification through AAPC or AHIMA. Candidates without certification will not be considered
- 4+ years of experience in medical claims professional procedure coding and processing
- Experience in reading, interpreting and applying Medicare and CMS Claims and Policies (NCD/LCD/NCCI)
- Solid knowledge of Medicare/CMS claims regulations and policies
Note: All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy
California, Colorado, Connecticut, Nevada, New Jersey, New York, Rhode Island, or Washington Residents Only: The hourly range for California/Colorado/Connecticut/Nevada/New Jersey/New York/Rhode Island/Washington residents is $27.07 to $53.08. 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.
UnitedHealth Group Mission
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 and Inclusion
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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