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- Pittsburgh, PA
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FWAE Claims Analyst - Pittsburgh, PA
UnitedHealth Group • Pittsburgh, PA
Posted 10 days ago
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Investigate Optum Waste and Error stopped claims by gathering information, researching state and federal guidelines, and following internal procedure to determine the viability of the claim for further review in a production environment.
Clinical Case Reviews - 75%
- Perform clinical review of professional (or facility) claims vs. medical records to determine if the claim is supported or unsupported
- Maintain standards for productivity and accuracy. Standards are defined by the department.
- Provide clear and concise clinical logic to the providers when necessary
- Analyze claims for pricing errors
- Attend and provide feedback during monthly meetings with assigned internal customer department
- Provide continuous feedback on how to improve the department relationships with internal team members and departments
- Keep up required Coding Certificate and / or Nursing Licensure
- Complete compliance hours as required by the department
- High school diploma / GED (or higher)
- Medical record coding experience
- Working knowledge of the healthcare insurance / managed care industry
- Previous experience in claim processing, healthcare provider information and healthcare billing practices
- Working knowledge of medical terminology and claim coding
- Proficient with personal computers, including Microsoft Suite of products; Microsoft Word (ability to create / edit document); Microsoft Excel (VLOOKUP and formulas); Microsoft PowerPoint (create / edit presentations); Microsoft Outlook (compose email, update calendar)
- Coding Certificate or Nursing Licensure and/or 5+ years claims processing/analyst experience, for example:
- 5+ years of claims processing/analyst experience
- Certified Inpatient Coder (CIC)
- Certified Outpatient Auditor (COC)
- Certified Professional Medical Auditor (CPMA)
- Certified Coding Specialist (CCS)
- Previous presentation or policy documentation experience
- Strong written and verbal communications skills
- Strong customer service skills
- Ability to work in a team
- Strong analytical and problem solving skills
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: claims, FWAE, processing, research, adjustment, fraud, waste, error, cost saving, data integrity, process optimization, data security, data analyst, Excel, Vlookup, clinical, coding, nurse, CIC, COC, CPMA, CCS, medical records, billing, claim coding