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  • Pittsburgh, PA

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FWAE Claims Analyst - Pittsburgh, PA

UnitedHealth Group • Pittsburgh, PA

Posted 10 days ago

Job Snapshot

Healthcare - Health Services
General Business, Health Care

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Job 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

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.

Primary Responsibilities:

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
Other internal customer correspondence and team needs  – 15%
  • 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
Continue education – 10%
  • Keep up required Coding Certificate and / or Nursing Licensure
  • Complete compliance hours as required by the department

Required Qualifications:

  • 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)

Preferred Qualifications:

  • Previous presentation or policy documentation experience
Soft Skills:
  • Strong written and verbal communications skills
  • Strong customer service skills
  • Ability to work in a team
  • Strong analytical and problem solving skills
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.

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

Job ID: 2551_799494
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