Clinical Appeals Auditor - Eden Prairie, MN

Unitedhealth Group Inc. Eden Prairie , MN 55344

Posted 2 months ago

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.

Primary Responsibilities:

  • 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

Required Qualifications:

  • Bachelor's degree

  • 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

Preferred Qualifications:

  • Master's degree

  • Licensed Clinician

  • Managed care experience

  • Behavioral health experience

  • Experience with grievances, appeals, denials

  • Audit experience

  • Experience working with providers

  • Quality improvement experience

  • Compliance 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,

Minnesota


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Clinical Appeals Auditor - Eden Prairie, MN

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