M&R - QRT Claims Quality / Audit Representative 1st pass Hospital - National Remote

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

The health care system is still evolving at a rapid pace. Technology is driving new advances in how patient care is delivered and how it's reimbursed. Now, UnitedHealth Group invites you to help us build a more accurate and precise approach to claims adjudication. In this role, you'll be responsible for the implementation and day to day performance of process activities related to claims research and resolution. This includes the review of claims, contracts, and fee schedules to identify processing, procedural, systemic, and billing errors. Join us and build your career with an industry leader.

This role will support M&R COSMOS claim operations through auditing and remediation efforts to improve quality results. Responsible for all aspects of quality assurance within the Claims job family. Conducts audits and provides real time feedback to reduce errors and improve processes and performance.

This position is full-time. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 5:00am - 8:00pm. It may be necessary, given the business need, to work occasional overtime. Training will be conducted virtually from your home.

*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.

Primary Responsibilities:

• Objectively review 1st Pass Hospital claims through the QRT audit process to include both end-to-end and focus audits.
• Demonstrates a depth of knowledge/skills in own area and is often able to apply this outside of own function.
• Conduct QRT Tool and SharePoint maintenance to ensure timely follow up and accuracy of auditing information and escalations.
• Collaboratively work with appropriate parties to identify trends/root cause of errors and opportunities for rework reduction.
• Act as a resource for others and escalate issues as needed
• Participate in meetings with multiple levels of leadership reviewing quality results as needed
• Provide professional and clear communication within audit information following outcome-based rules applications.
• Retain self-proficiency (e.g., maintain/increase skills) of competencies related to quality review areas and claims processing systems.
• Plans, prioritizes, organizes, and completes work to meet established objectives and deadlines.
• Identify and escalate process improvement opportunities to facilitate problem resolution and idea generation
• The ability to prioritize multiple responsibilities in a fast-paced environment

This is a challenging role with serious impact. You'll be providing a senior level of support to a fast paced, intense, and high-volume claims operation where accuracy and quality are essential.

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:

• High School Diploma / GED (or higher) OR equivalent work experience
• 6+ months experience processing M&R 1st Pass Hospital claims on the COSMOS platform
• Completion of full reviews uptrained
• Moderate proficiency with computer and Windows PC applications, which includes the ability to navigate and learn new and complex computer system applications

Preferred Qualification:

• Previous Auditing experience

Telecommuting Requirements:

• Required to have a dedicated work area established that is separated from other living areas and provides information privacy
• Ability to keep all company sensitive documents secure (if applicable)
• Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service

Soft Skills:

• Excellent communication and interpersonal skills
• Proficient in managing multiple tasks to meet deadlines
• Ability to work independently and in cross-functional teams
• Able to work with minimal supervision/direction
• Passion for quality

Careers with UnitedHealthcare. Work with a Fortune 5 organization that's serving millions of people as we transform health care with bold ideas. Bring your energy for driving change for the better. Help us improve health access and outcomes for everyone, as we work to advance health equity, connecting people with the care they need to feel their best. As an industry leader, our commitment to improving lives is second to none.

California, Colorado, Connecticut, Nevada, Washington, or New York, Rhode Island Residents Only: The salary range for California / Colorado / Connecticut / Nevada / Washington / New York / Rhode Island residents is $16.00 - $31.44. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you'll find a far-reaching choice of benefits and incentives.

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.

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.

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