Remote Special Investigation Coding Consultant – National

Optum

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Requisition Number: 2194694
Job Category: Medical & Clinical Operations
Primary Location: Dallas, TX
(Remote considered)

You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

This position is full-time, Monday – Friday. Employees are required to work our normal business hours of 8:00am – 5:00pm CST. It may be necessary, given the business need, to work occasional overtime or weekends.

We offer weeks of paid on-the-job training. The hours during training will be 8:00am to 5:00pm CST, Monday – Friday.  Training will be conducted virtually from your home.

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

Primary Responsibilities:

  • Reviews prepay claims with corresponding medical records to determine payment accuracy. (70%)
  • Reviews applicable policies, CPT guidelines and contracts as they pertain to clinical review. (10%)
  • Participates in regulatory meetings with client (5%)
  • Participates in meetings with providers, advocates and legal to assist with provider abrasion. (5%)
  • Performs additional projects as needed by the business or Client; analyzes data; meets with internal and external stakeholders as necessary for resolution. (5%)
  • Continuous monitoring of claim inventory in order to adhere to performance guarantees. (5%)

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:

  • Licensed registered nurse (RN), Licensed practical nurse (LPN) and/or Certified Coder with a minimum of 3+ years coding experience (surgical, hospital, clinic settings)
  • Knowledge of PC based software
  • CPT & ICD coding experience
  • Must be 18 years of age or older
  • Ability to work our normal business hours of 8:00am – 5:00pm CST, Monday – Friday. It may be necessary, given the business need, to work occasional overtime or weekends

Preferred Qualifications:

  • Experience with health insurance billing/coding

Telecommuting Requirements:

  • Ability to keep all company sensitive documents secure (if applicable)
  • Required to have a dedicated work area established that is separated from other living areas and provides information privacy.
  • Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service.

Soft Skills:

  • Ability to prioritize and manage multiple tasks.
  • Proven ability to work in a team setting
  • Excellent oral and written communication skills and presentation skills.
  • Critical thinking, problem solving and analytical skills.

California, Colorado, Connecticut, Nevada, New Jersey, New York, Washington or Rhode Island Residents Only: The hourly range for California / Colorado / Connecticut / Nevada / New York / New Jersey / Washington / Rhode Island residents is $22.45 – $43.89 per hour. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.