Position Description:Welcome to one of the toughest and most fulfilling ways to help people, including yourself. We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement. Join us and start doing your life's best work.(sm)This position is responsible for all aspects of assigned cases for analyzing and appeal / dispute process of conditional payments.Primary Responsibilities: Responsible for all conditional payment analyzing for Medicare, Medicare Advantage Plans and Medicaid for workers' compensation, auto and liability cases. Responsible for all appeals and disputes on conditional payments when requested by client. Serve as the liaison between Optum Settlement Solutions and BCRC / CRC / CMS / MAPs / Medicaid. Performs follow up for final settlement documents and distributes to the lead contractor once received. Works directly with legal staff for final demands or appeals process. Processes all mail related to appeals and disputes from the BCRC / CRC. Manages the required paperwork such as Letters of Authorization, Proof of Representation and Consent to Release forms Work directly in the Medicare Secondary Payer Recovery portal (internet - based) and Optum's Medicare Connect portal Distributes the status responses that the BCRC / CRC generates. Provides status updates to client regarding conditional payment issues. Responsible for handling all phone calls, emails and faxes on assigned cases. Participates on client conference calls and trains new associates within the conditional payment team, as needed. Works with Management on special projects as necessary. Performs other job functions as assigned by management.
Requirements:High School Diploma / GED or higher 3+ years of complex Claims handling / adjuster experience (i.e. Worker's Compensation / Auto / Liability, Case Management, High Dollar Claims, Medicare Secondary Payor Services) Experience with Microsoft Word (Ability to create and edit professional documents) Experience with Microsoft Outlook (Ability to create and send emails and calendar invites) Experience with Microsoft Excel (Ability to edit, filter, sort, analyze data and use formulas)Assets:Associate's Degree (or higher) Medical, Paralegal, Adjuster background or prior Conditional Payment Negotiation experience Previous Medicare Secondary Payer Recovery experience Previous Medical Claims Appeals experience Knowledge of / work experience utilizing ICD - 9 / IC - 10 coding and medical terminology understanding Physical Requirements and Work Environment:Extended periods of sitting at a computer and use of hands / fingers across keyboard or mouse Office environmentThis position requires ACHA Level II Background checks (fingerprinting) by the State of Florida for all Clinicians that have face-to-face contact with members and will require renewal every five years. OptumRx is an empowering place for people with the flexibility to help create change. Innovation is part of the job description. And passion for improving the lives of our customers is a motivating factor in everything we do. If you're ready to talk about groundbreaking interactions, let's talk about what happens when a firm that touches millions of lives decides to gather results from millions of prescriptions every month and analyze their impact. Let's talk about smart, motivated teams. Let's talk about more effective and affordable healthcare solutions. This is caring. This is great chemistry. This is the way to make a difference. We're doing all this, and more, through a greater dedication to our shared values of integrity, compassion, relationships, innovation and performance. Join us and start doing your life's best work.SMDiversity 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: Optum, OptumRx, conditional payment, medicare, medicaid, claims, worker's compensation, case management, analyst, analysis
Our mission is to help people live healthier lives and to help make the health system work better for everyone.- We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities. - We work with health care professionals and other key partners to expand access to quality health care so people get the care they need... at an affordable price. - We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions.