Payment Integrity Consultant

UnitedHealth Group • Tampa, FL

1d • Remote

About The Position

This position is National Remote. You’ll enjoy the flexibility to telecommute from anywhere within the U.S. as you take on some tough challenges.
Optum Insight is improving the flow of health data and information to create a more connected system. We remove friction and drive alignment between care providers and payers, and ultimately consumers. Our deep expertise in the industry and innovative technology empower us to help organizations reduce costs while improving risk management, quality and revenue growth. Ready to help us deliver results that improve lives? Join us to start Caring. Connecting. Growing together.
This position is full-time (40 hours/week), Monday - Friday. Employees are required to have flexibility to work any of our shift schedules during our normal business hours of 8:00am - 5:00pm CST. It may be necessary, given the business need, to work occasional overtime.
We offer on-the-job training. The hours of training will be aligned with your schedule during our normal business hours.
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.

Requirements

• High School Diploma / GED
• Must be 18 years of age OR older
• 3+ years of experience reviewing claims data with contractual reimbursement and payment policy review, to identify incorrect reimbursement
• 2+ years of experience analyzing data to identify new overpayment and / OR cost - saving opportunities
• 2+ years of experience working as a claims auditor, independently without direct supervision
• Experience performing independent research to work toward creative solutions
• Experience recalculating expected claim reimbursement
• Experience with Microsoft Office including Microsoft Word and Microsoft Outlook
• Experience identifying and presenting trends in large datasets
• Advanced Microsoft Excel experience (formula creation, Pivot Tables/VLOOKUP), OR experience working with SQL (basic scripting experience)
• Ability to work Monday - Friday, in any of our shift schedules during our normal business hours of 8:00am - 5:00pm CST

Nice To Haves

• Experience identifying payment errors by reviewing data
• Experience reviewing claim data with COB (Coordination Of Benefits)
• Medical coding knowledge OR experience

Responsibilities

• Become an expert in assigned clients payment systems and policies
• Identify issues with client overpayments through the advanced analysis of client data
• Present overpayments to client through documentation and concept presentations
• Document all new concepts and train internal analysts on identification and correct payment calculations
• Maintain existing productions queries and enhance or correct as necessary
• Achieve annual trend approval rate goals
• Serves as a resource to others on issues pertaining to client policies and overpayment concepts
• Other duties/projects as assigned

Benefits

• 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED