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SIU Clinical Investigator - Eden Prairie, MN OR US Telecommute

UnitedHealth Group


Location:
Eden Prairie, MN
Date:
04/21/2017
Job Code:
1744065
Apply on the Company Site
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Job Details


SIU Clinical Investigator - Eden Prairie, MN OR US Telecommute(Job Number:712793)
Description

Position Description:  

 

Energize your career with one of Healthcare’s fastest growing companies.  

 

You 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.

 

This 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 leader.

 

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.


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 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 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-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
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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