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Job Details


UnitedHealth Group

Field Based Certified Compliance Auditor - Massachusetts

Healthcare

All

Full Time

On Site

No

Boston, Massachusetts, United States

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 full-time (40 hours/week) Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of (8:00am - 5:00pm). It may be necessary, given the business need, to work occasional overtime.

Primary Responsibilities:

  • Examine, assess, and document business operations and procedures to ensure data integrity, data security and process optimization
  • Investigate, recover, and resolve all types of claims as well as recovery and resolution for health plans, commercial customers, and government entities
  • Investigate and pursue recoveries and payables on subrogation claims and file management
  • Initiate phone calls to members, providers, and other insurance companies to gather coordination of benefits information
  • Process recovery on claims
  • Ensure adherence to state and federal compliance policies, reimbursement policies, and contract compliance
  • Use pertinent data and facts to identify and solve a range of problems within area of expertise

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)
  • Unrestricted RN/LPN license OR Coding Certification (CPC, CIC, CPMA, OR RHIT)
  • Experience working with medical claims platforms
  • 2+ years of experience with claims auditing and researching claims information
  • 1+ years of experience analyzing data and identify cost saving opportunities
  • Knowledge of claims processing systems and guidelines/processes
  • Intermediate skills with Microsoft Excel (create, edit, sort, filter, pivot tables)
  • Experience in healthcare
  • Ability to travel up to 25% of the time
  • Ability to work an 8 hour shift between 8:00am – 5:00pm including the flexibility to work occasional overtime per business need
  • Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation.

Preferred Qualifications:

  • Bachelor’s Degree (or higher)
  • Experience with chart abstraction
  • 1+ years project management experience
  • Knowledge of Medicaid/Medicare Reimbursement methodologies
  • Microsoft Access (create, edit, format, manipulate data)

UnitedHealth Group requires all new hires and employees to report their COVID-19 vaccination status.

Military & Veterans find your next mission: We know your background and experience is different and we like that. UnitedHealth Group values the skills, experience and dedication that serving in the military demands. In fact, many of the values defined in the service mirror what the UnitedHealth Group culture holds true: Integrity, Compassion, Relationships, Innovation and Performance. Whether you are looking to transition from active duty to a civilian career, or are an experienced veteran or spouse, we want to help guide your career journey. Learn more at [Register to View]

Learn how Teresa, a Senior Quality Analyst, works with military veterans and ensures they receive the best benefits and experience possible. [Register to View]

Careers with OptumInsight. Information and technology have amazing power to transform the Healthcare industry and improve people's lives. This is where it's happening. This is where you'll help solve the problems that have never been solved. We're freeing information so it can be used safely and securely wherever it's needed. We're creating the very best ideas that can most easily be put into action to help our clients improve the quality of care and lower costs for millions. This is where the best and the brightest work together to make positive change a reality. This is the place 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.

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