Clinical Facility Investigator - Remote

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

Combine two of the fastest - growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making Healthcare data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.SM

The Clinical Facility Investigator will work with a team on researching issues to determine feasibility of reducing medical costs through prospective solutions of claim system processes and claim business rules.

This position is full-time (40 hours/week) Monday - Friday. Employees are required to work our normal business hours of 8:00am - 5:00pm. It may be necessary, given the business need, to work occasional overtime or weekends. Training will be conducted virtually from your home.

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

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)
* Medical record facility coding experience
* Coding Certification (example) Certified Inpatient Coder (CIC), Certified Outpatient SAuditory (COC), Certified Professional Coder (CPC), Certified Professional Medical Auditor (CPMA), Certified Coding Specialit (CCS)
* Previous experience in claim processing, healthcare provider information and healthcare billing practices
* Working knowledge of medical terminology and claim coding.
* Moderate proficiency of Microsoft office, Microsoft Word, Microsoft Excel (open, create, edit, save, and send Documents and Spreadsheetss)
* DRG coding Experience

Preferred Qualifications:

* Knowledge of CMS and AMA coding rules specific to ICD-10, PCS, CPT, HCPCS
* Microsoft Access (create and modify queries and reports)
* Knowledge of Medicaid / Medicare reimbursement methodologies
* Experience working in the healthcare industry with claims and or financial recovery/settlements
* Experience working with long term care services

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:

* Strong written and verbal communications skills.
* Strong customer service skills.
* Ability to work in a team.

Physical and Work Environment:

* Frequent speaking, listening using a headset, sitting, use of hands/fingers across keyboard or mouse, handling other objects, long periods working at a computer
* Service center environment with moderate noise level due to Representatives talking, computers, printers, and floor activity

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

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

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

Colorado Residents Only: The hourly range for Colorado residents is $25.63 to $45.72. Pay is based on several factors including but not limited to education, work experience, certifications, etc. As of the date of this posting, In addition to your salary, UHG offers the following benefits for this position, subject to applicable eligibility requirements: Health, dental, and vision plans; wellness program; flexible spending accounts; paid parking or public transportation costs; 401(k) retirement plan; employee stock purchase plan; life insurance, short-term disability insurance, and long-term disability insurance; business travel accident insurance; Employee Assistance Program; PTO; and employee-paid critical illness and accident insurance.

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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