The Audit & Recovery Analyst position is to participate with the audit and recovery team in the timely implementation and completion of audit initiatives, and the related activities. Analyze, evaluate, and perform timely audits based on Optum policies and consistent with the nationally published guidelines regarding procedural documentation. Address provider calls regarding the audit process. Strong decision-making skills involving medical record documentation and minimum medical record documentation requirements.
You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:- Maintain understanding of procedural codes and the documentation required to verify services and substantiate payment
- Assist in the development and implementation audit and the related activities including printing and preparing letters requesting medical records, completion of the prepared audits and processing and completing appeals of adverse determinations of payment
- Performs other projects, tasks and duties as assigned by management, professional committees and/or facilitate said processes
- Ability to interface with supporting departments regarding the implementation of audit and recovery issues such as committee activities, appeals and changes in clinical submission
- Participation in policy development
- Be able to field questions from providers regarding the purpose and right of Optum Physical Health Solutions in conducting medical records audit
- Ability to solve problems and deal with a variety of specific variations in situations where only limited standardization exists
- Become familiar with the interaction with ODAR and completing the appeals of overpayment determinations
- Demonstrate effective written and oral communication skills
- Maintain positive and productive relationships with provider community, clinical staff, and all other personnel
- Accurately record all verbal communications with providers into communication log database
- Ability to interact with audit and recovery staff in the completion of audit related activities
- Ability to effectively present information and respond to questions from providers, audit and recovery staff, management, and other employees
- Working knowledge of various software applications to perform the requirements of the position
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:- Undergraduate degree in specialized Physical medicine from an accredited college or university
- Current Licensed or Certified Physical Therapist or Chiropractor with state-licensing agency
Preferred Qualifications:- Clinical practice experience
- Thorough detailed working knowledge of procedural coding and the required supporting documentation
- Proven solid decision-making skills involving clinical and administrative data
*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $72,800 - $130,000 annually based on full-time employment. We comply with all minimum wage laws as applicable.
Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
