For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us and help people live healthier lives while doing your life's best work.(sm)
The Clinical Appeals Auditor is an individual contributor role responsible for an exciting variety of responsibilities in Specialty Networks of OptumHealth. We are looking for someone who is detail - oriented, yet can see the big picture. We are in need of that rare person who balances strong analytical skills with a positive, team - focused personality.
Preparation of files and external facing documents for regulatory and customer audit
Audit of authorization, denial, appeal, or grievance case files, letters and universes against criteria
Read and interpret federal or state legislation to determine requirements for appeals and grievances
Audit and review of policies and procedures, letters, and letter attachments against legislative requirements and business practices
Gather information for audits or market conduct exams and execute corrective action plans
Coordinate data collection for required reporting
Drive assigned projects through completion
2 years of experience in a hands-on behavioral health role
Experience in reading and understanding legislation to drive operationalization
Intermediate or better proficiency in MS Word, MS Excel, Adobe Professional and PowerPoint
Managed care experience
Behavioral health experience
Experience with grievances, appeals, denials
Experience working with providers
Quality improvement experience
Medicare reporting experience
Medicare / Medicaid experience
Excellent verbal and written, presentation/communication skills
Exceptional writing skills
Ability to manage multiple projects at once
Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity 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.
Job Keywords: Appeals, Grievances, Auditor, Medicaid, Clinical Appeals, MN, Eden Prairie,
Unitedhealth Group Inc.