SIU Clinical Investigator - Eden Prairie, MN OR US Telecommute(Job Number:712793)
your career with one of Healthcare’s fastest growing companies.
dream of a great career with a great company - where you can make an impact and
help people. We dream of giving you the opportunity to do just
this. And with the incredible growth of our business, it’s a dream that
definitely can come true. Already one of the world’s leading Healthcare
companies, UnitedHealth Group is restlessly pursuing new ways to operate our
Service Centers, improve our Service levels and help people lead healthier
lives. We live for the opportunity to make a difference and right now, we are
living it up.
opportunity is with one of our most exciting business areas: Optum - a growing
part of our family of companies that make UnitedHealth Group a Fortune 14
Optum helps nearly 60
million Americans live their lives to the fullest by educating them about their
symptoms, conditions, and treatments; helping them to navigate the system,
finance their Healthcare needs, and stay on track with their Health goals. No
other business touches so many lives in such a positive way. And we do it all
with every action focused on our shared values of Integrity, Compassion,
Relationships, Innovation, and Performance.
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.
clinical coverage review of post-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
clinical coding review to ensure accuracy of medical coding and utilizes
clinical expertise and judgment to determine correct coding &
aberrant billing patterns and trends, evidence of fraud, waste or abuse,
and recommends providers to be flagged for review.
and manages daily case review assignments, with a high emphasis on
clinical support and expertise to the other investigative and analytical
in provider/client/network meetings, which may include provider education
through written communication.
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-MN-Eden Prairie
Other Location US-TX-Dallas, US-FL-Tampa, US-CT-Hartford, US-AZ-Phoenix, US-MN-Minneapolis
Organization Optum Ops-Payment Integrity
Number of Openings 1