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Clinical Investigator SIU - TN Telecommute

UnitedHealth Group


Location:
Brentwood, TN
Date:
08/22/2017
2017-08-222017-09-20
Job Code:
1774693
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Job Details


Clinical Investigator SIU - TN Telecommute(Job Number:725757)
Description

Position Description:

Welcome to one of the toughest and most fulfilling ways to help people, including yourself. We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement. Join us and start doing your life's best work.SM

The Clinical Investigator SIU handles information about patient services and how the services are paid by investigating and pursuing recoveries through contact with various parties. The representative manages subrogation files, negotiates settlements, and ensures adherence to compliance policies.

Primary Responsibilities:
  • Investigates, reviews, and provides clinical and / or coding expertise in the application of medical and reimbursement policies within the claim adjudication process through file review.  This could include Medical Director / physician consultations, interpretation of state and federal mandates, applicable benefit language, medical and reimbursement policies and consideration of relevant clinical information.
  • Performs clinical coverage review of current-service claims, which requires interpretation of state and federal mandates, applicable benefit language, medical & reimbursement policies, coding requirements and consideration of relevant clinical information on claims with aberrant billing patterns.
  • Performs clinical coding review to ensure accuracy of medical coding and utilizes clinical expertise and judgment to determine correct coding & billing.
  • Identifies aberrant billing patterns and trends, evidence of fraud, waste or abuse, and recommends providers to be flagged for review.
  • Maintains and manages daily case review assignments, with a high emphasis on quality.
  • Provides clinical support and expertise to the other investigative and analytical areas.
  • Participates in provider / client / network meetings, which may include provider education through written communication.
  • Participates in training of new staff, and serves as a clinical resource to other areas within the clinical investigative team.

Job Claim Recovery/Resol/COB/Subro
Primary Location US-TN-Brentwood
Other Location 
Organization Optum Ops-Payment Integrity
Schedule Full-time
Number of Openings 1
Apply on the Company Site

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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