Remote Utilization Review Jobs in Minnesota (NOW HIRING)

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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.  

Position in this function is reporting to the Provider Education and Escalations Manager, the Coding Education Consultant is part of a team responsible for conducting coding audits for escalated claims and providing coding education to providers and facilities who are inaccurately billing.

This role will primarily focus on the presentation of medical coding content on common billing errors, performing audits on escalated claims, and providing feedback on completed claim audits. This position requires the coder to present/deliver coding education in a variety of settings both internally and externally: (not limited to) educational boot camps, expo event class, provider/facility offices, method of delivery is mainly via telephonic or virtual (i.e.: Webex) meetings.

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

Primary Responsibilities:

• Create and deliver presentation materials to facilitate provider education
• Lead provider education meetings to drive issue resolution, including potential onsite provider meetings
• Apply principles of adult learning and training best practices to deliver effective and innovative training material
• Create supporting materials for learning activities (e.g., agendas, schedules, letters, audio/visual aids, etc.)
• Leverage/modify existing training solutions to meet current needs
• Act as a subject matter expert for internal and external partners in the form of assistance with medical coding, documentation requirements based off industry standards
• Ensures adherence to state and federal mandates for all coding guidance, applicable benefit language, medical & reimbursement policies, coding requirements and consideration of relevant clinical information
• Possesses strong decision-making skills on complex claim audits
• Analyze and interpret claims data and medical records/documentation to understand the historical activity and determine validity of the payment/denial on a claim
• Identifies aberrant billing patterns and trends, evidence of fraud, waste, or abuse, and recommends providers to be flagged for review
• Maintains and manages daily assignments, with accountability to quality, utilization, and productivity standards
• Discussing the findings as a collaborative team with UHN advocacy, UHC PPS and analyst before approaching the provider call
• Maintaining positive provider and network relationships
• Actively owning and resolving issues for Best in Class and / or high-profile providers encountered during education session
• Analyze data trends prior to education outreach to ensure provider billing errors are addressed in a holistic fashion
• Managing individual workload with a high emphasis on quality
• Demonstrated written, verbal, analytical, organizational, time management and problem-solving skills with proven ability to work independently
• Assume additional responsibilities as assigned

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:

• Current, active, unrestricted Inpatient Coder Certification (CIC, CCS, RHIT, RHIA etc.)
• 5 years of experience as a Certified Inpatient Coder in a healthcare setting including knowledge of industry terminology, and regulatory guidelines
• 3 years providing formal training on medical coding and/or customer service experience
• Fully proficient with MS products such as Word, PowerPoint, and Excel (Pivot Tables, etc.)

Preferred Qualifications:

• A current, active, unrestricted nursing license (RN, LPN, etc.)
• Training Certification
• CDI Certification
• Managed care experience
• Investigational and/or auditing experience
• Knowledge of claims platforms

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. 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. The salary for this role will range from $72,800 - $130,000 annually based on full-time employment. We comply with all minimum wage laws as applicable.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.    

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.