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Senior Recovery & Resolution Analyst - US Telecommute

UnitedHealth Group

Minneapolis, MN
Job Code:
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Job Details

737612 Senior Recovery Resolution Analyst US Telecommute

Senior Recovery & Resolution Analyst - US Telecommute (737612)

Position 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  will work with a team on researching issues to determine feasibility of reducing Senior Recovery / Resolution Analyst medical costs through prospective solutions of claim system processes and claim business rules.

Primary Responsibilities:

  • Ensure adherence to state and federal compliance policies, reimbursement policies and contract compliance.
  •  Performs clinical coverage review of post - service, pre - payment 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

Coding Designation Certification Definitions:

  • CPC: Certified Professional Coder
  • CPC-H: Certified Professional Coder – Hospital
  • CPC-P Certified Professional Coder – Payer
  • CCA: Certified Coding Associate
  • CCS: Certified Coding Specialist
  • CCS-P: Certified Coding Specialist – Physician based
  • RHIT: Registered Health Information Technologist
  • RHIA: Registered Health Information Administrator


  • High school diploma / GED or higher
  • 1+ years of current CPT/HCPCS coding experience (entering codes, auditing etc.)
  • Possess an unrestricted nursing license (RN / LVN / LPN) or are a current certified coder (CPC / CCS / RHIT etc.)
  • Ability to work an 8-hour shift between 7:00 am to 5 pm CST Monday through Friday and available to work overtime as business needs require


  • Bachelor's Degree (or higher)
  • Healthcare Claims experience
  • Managed Care experience
  • Investigations and / or Auditing experience
  • Knowledge of Medicaid / Medicare Reimbursement methodologies

Soft Skills:

  • Analytical problem - solving skills

Physical Requirements and Work Environment:

  • Frequent speaking, listening using a headset, sitting, use of hands / fingers across keyboard or mouse, handling other objects, extended periods working at a computer
  • Service center environment with moderate noise level due to Representatives talking, computers, printers, and floor activity

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system 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

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.

Key Words: US Telecommute; Optum, Claims, Nursing, Medical Records; provider billing

Job Details

  • Contest Number737612
  • Job TitleSenior Recovery & Resolution Analyst - US Telecommute
  • Job FamilyClaims
  • Business SegmentOptum Operations

Job Location Information

  • Minneapolis, MN
    United States
    North America
  • Other LocationsHartford, CT
    Phoenix, AZ
    Dallas, TX
    Tampa, FL

Additional Job Detail Information

  • Employee StatusRegular
  • ScheduleFull-time
  • Job LevelIndividual Contributor
  • ShiftDay Job
  • TravelNo
  • Telecommuter PositionYes
  • Overtime StatusNon-exempt

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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