Appeals Specialist - Colorado Remote

Unitedhealth Group Edwards , CO 81632

Posted 2 months ago

Combine two of the fastest - growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making Healthcare data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.

The Appeals Specialist is responsible for the following distinct support functions for the Appeals Department:

  • Analyzing appeals and resolution matters of a complex nature, and composing/drafting appeal responses and related correspondence. Responsibilities for this role include, but are not limited to: reviewing, analyzing, and responding to appeals, inquiries, and complaints within established time frames; ensuring appeal and resolution responses are complete, grammatically correct, and of a nature that appropriately represents the company's position; maintain company's Client Matrix and other reports or documentation as they relate to each client's appeal standards and requirements;

  • Contributing to the development of Appeals functions, including workflows, policies and procedures, staff training, and documentation;

  • Acting as a departmental resource on Appeals matters as required; performing research as warranted; responding to attorney inquiries and litigation notices; and

  • Special projects as assigned

If you are located in the Colorado area, you will have the flexibility to telecommute* as you take on some tough challenges.

We offer 8-10 weeks of paid training. The hours during training will be 8:00am to 5:00pm, 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:

  • Coordinate work for, and work with, Claim Representatives, Appeal Analysts, triaging medical records, setting up claim appeals in Optum Systems, and other duties to be determined.

  • Set up Appeals (includes receive, analyze, evaluate, and track appeal documents; follow inquiries and complaints through final resolution) by established processes and procedures, and within established time standards.

  • Provide quality written responses (applying the appropriate composition, grammar, punctuation, and spelling) to appeals, inquiries, negotiations, and complaints within established time standards.

  • Create, compose, and maintain appeal response templates, and routinely review to update language, and apply and coordinate such updates and changes under the guidance of the Director of the Resolution & Appeals Division and other Management as appropriate.

  • Coordinate with Appeal Department Management and Senior Specialist, as required, to compose appeal responses.

  • Communicate/interact with clients and providers (telephone, email, other written correspondence, participate in meetings) as required.

  • Perform research and provide documentation for Appeal matters as requested within required time frames

  • Update claims (logs, dates, processes, documentation) in Equian system following company standards within established time standards

  • Update and maintain the accuracy of the Appeal section of the Client Matrix for each client to ensure appeal response requirements (such as timelines, policies, and procedures) are available for reference to set up claim appeals when received

  • Perform peer QA of appeal responses as-needed

  • Participate in department and company meetings as requested

  • Participate on committees and special projects (as assigned or required) to ensure consistency of the claim review from the initial report through the appeal process

  • Meet time, quality, and customer satisfaction standards

  • Complete special projects related to appeals as assigned, within required time standards

  • Understand, maintain, and apply HIPAA, confidentiality, and privacy standards to assigned work, as well as ERISA and fraud, waste, and abuse laws

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 required

  • 2+ years of health care industry experience and/or 2+ years of medical insurance experience

  • 2+ years of appeals experience

  • Familiarity with appeal regulations, medical terminology, and coding

  • Familiarity with plan benefit, ERISA, Medicaid, and Medicare requirements

  • 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

Preferred qualifications:

  • Bachelor's degree preferred

  • Coding Accreditations preferred (Certified Professional Coder, COC, CIC or RHIT, etc

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:

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.

Colorado Residents Only: The hourly range for Colorado residents is $15.00 to $25.19. Pay is based on several factors including but not limited to education, work experience, certifications, etc. As of the date of this posting, In addition to your salary, UHG offers the following benefits for this position, subject to applicable eligibility requirements: Health, dental, and vision plans; wellness program; flexible spending accounts; paid parking or public transportation costs; 401(k) retirement plan; employee stock purchase plan; life insurance, short-term disability insurance, and long-term disability insurance; business travel accident insurance; Employee Assistance Program; PTO; and employee-paid critical illness and accident insurance.

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, medical, medical insurance, coding, appeals, work at home, work from home, WAH, WFH, remote, telecommute, hiring immediately

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Appeals Specialist - Colorado Remote

Unitedhealth Group