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Medical Claims Analyst - Work from home

Company: UnitedHealth Group
Location: Grand Junction
Posted on: June 9, 2021

Job Description:

If you are located in the Colorado area, you will have the flexibility to telecommute (work from home) as you take on some tough challenges. It's that time, isn't it? You're ready for the next step forward and an opportunity to build on your skills. And it just so happens that there's never been a better time to get on the team at UnitedHealth Group. We've built one of the world's most effective and respected claims processing teams. And that's where you come in. We'll look to you to maintain our reputation for service, accuracy and providing a positive claims experience. We'll back you with the great training, support and opportunities you'd expect from a Fortune 10 leader. A Medical Claims Analyst (MCA) is responsible for the intake processing and triage of all initial claim documents in a high volume environment. This includes but is not limited to referral processing, obtaining required documents, medical records sorting and processing, preparing payment calculations, preparing the claim for a Nurse review, apply all Nurse findings to the claim, prepare and send reports, prepare and send provider packets. Training will be conducted virtually from your home. All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy. Primary Responsibilities Review and process all incoming claim referrals. Ensure completeness and legibility of documents, coordinating with customer service, internal departments andor facilities to obtain additional information as needed Communicate with staff and facilities to gather pertinent claim information needed to process claims Assign claims to data entry if the manual conversion process is not possible Review and categorize incoming medical records according to defined process including saving to appropriate folders, sorting scanning as needed and maintain the Medical Records storage closet Using the appropriate templates, create client specific letters and other communications Review communications, including fax and e - mail, directing communications to appropriate personnel, documenting all pertinent information in appropriate systems according to company standards Manage personal claim work queue by prioritizing deadlines for claims at various phases Apply judgment in accordance with company policies and contractual agreements to determine how to proceed with a claim. Understand complete line - by - line analysis of hospital bills utilizing Excel and internal software system for alignment with internal and external policies and procedures and collaborate with other teams as necessary Apply Clinical Forensic Review adjustments to data load Generate reporting and supporting documents for clients and medical facilities to support line - item edit rationale Perform self - quality checks on reports, including verification of formulas and adherence to internal and external policies and procedures Assist other employees through mentoring, skills training, job shadowing, answering questions, and peer feedback Track Record and end required number of tasks to Quality Assurance (QA) for accuracy check, according to QA levels Review QA feedback for inaccuracies, if appropriate, follow internal process for correction and removal Assist the Resolution and Appeals Department in creating additional reports and exhibits or making revisions to existing materials, as necessary Work with other teams to meet shared goals Meet time production, quality accuracy, and customer satisfaction standards during preliminary and final review processes Understand and maintain HIPAA confidentiality and privacy standards when completing assigned work Participate in department and company meetings as requested Complete special projects as assigned Working with business partners to address ongoing training through meeting, shadowing and mentoring Continuing development through Learning Management System (LMS) 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 Diploma GED (or higher) 2+ years of administrative experience (i.e. office, administrative, clerical, customer service, etc.) Experience with Microsoft Excel (ability to create, edit, filter and sort through spreadsheets) Experience with Microsoft Word (ability to create and edit documents) Experience with Microsoft Outlook (ability to sendreceive emails and calendar invites) Understand and maintain HIPAA confidentiality and privacy standards when completing assigned work Proficiency with computers and Windows PC applications, which includes the ability to learn new and complex computer system applications Must reside in the state of Colorado Must be able to work Monday through Friday 8am to 5pm MST If you need to enter a work site for any reason, you will be required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or similar UnitedHealth Group-approved symptom screener. When in a UnitedHealth Group building, employees are required to wear a mask in common areas. In addition, employees must comply with any state and local masking orders Telecommuting Requirements Required to have a dedicated work area established that is separated from other living areas and provides information privacy Ability to keep all company sensitive documents secure (if applicable) Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service Preferred qualifications Some College (or higher) 1+ year experience processing medical, dental or prescription claims Familiarity with UB04's UnitedHealth Group is an essential business. The health and safety of our team members is our highest priority, so we are taking a science driven approach to slowly welcome and transition some of our workforce back to the office with many safety protocols in place. We continue to monitor and assess before we confirm the return of each wave, paying specific attention to geography-specific trends. At this time, 90 of our non - clinical workforce transitioned to a work at home (remote) status. We have taken steps to ensure the safety of our 325,000 team members and their families, providing them with resources and support as they continue to serve the members, patients and customers who depend on us. You can learn more about all we are doing to fight COVID-19 and support impacted communities at httpswww.unitedhealthgroup.comnewsroomaddressing-covid.html httpswww.unitedhealthgroup.comnewsroomaddressing-covid.html Careers with OptumInsight. Information and technology have amazing power to transform the Healthcare industry and improve people's lives. This is where it's happening. This is where you'll help solve the problems that have never been solved. We're freeing information so it can be used safely and securely wherever it's needed. We're creating the very best ideas that can most easily be put into action to help our clients improve the quality of care and lower costs for millions. This is where the best and the brightest work together to make positive change a reality. This is the place 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. Keywords UnitedHealth Group, Unitedhealth care, health care, optum, administrative, Microsoft office, claims, medical, work at home, work from home, WAH, WFH, remote, telecommute, hiring immediately, RPO

Keywords: UnitedHealth Group, Grand Junction , Medical Claims Analyst - Work from home, Other , Grand Junction, Colorado

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