UnitedHealth Group is among the most ambitious Fortune 25 companies you'll ever meet. Through our family of businesses, we're working to make the health care system perform better for more people, in more ways than ever.
Simply put, we think the entire system can be greater than it's ever been. And that drives us to work harder, aim higher, and expect more from one another.
Here, you'll be empowered to make an immediate impact for millions of others. And you'll achieve more than you ever expected. How does that fit with your plans?
Healthcare Appeals Processor - Wausau, WI-316347
UnitedHealth Group is an innovative leader in the health and well-being industry, serving more than 55 million Americans. Through our family of companies, we contribute outstanding clinical insight with consumer-friendly services and advanced technology to help people achieve optimal health.
Description UnitedHealthcare is part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system.
When you work with UnitedHealthcare, what you do matters. It's that simple...and it's that challenging.
In providing consumer-oriented health benefit plans to millions of people, our goal is to create higher quality care, lower costs and greater access to health care. Join us and you will be empowered to achieve new levels of excellence and make a profound and personal impact as you contribute to new innovations in a vital and complex system.
Healthcare Appeals Processor - Wausau, WI
Position Description:
Positions in this function are responsible for providing expertise or general support to teams in reviewing, researching, investigating, negotiating and resolving all types of appeals.
Primary Responsibilities:
- Maintains a good understanding and interpretation of Plan Language of ALL Plan Benefits for assigned customer accounts including all product lines
- Reviews appeals based on priority basis by completion of expected turnaround time and in compliance with DOL regulations to avoid penalties/fines
- Completes a backend Quality Review by checking specific Plan language, verifying benefit information and reviewing bill copy for accuracy of Patient, Date of Service, dollar amount, CPT codes, and Provider name
- Reviews all documentation in specific system applications
- Recognizes when to refer claims to our compliance and/or legal department that have potential to become a legal/financial risk
- Recognizes concerns involving medical judgment issues and refers to Registered RN and determines what additional medical documentation is necessary and requests such information prior to referral
- Makes the appeal determination and generates a resolution letter and finalizes all documents related to an appeal review by closing out the database entries
- Makes sure the letter has all the correct information to be DOL and HIPAA compliant by including specific wording to Appeal Levels, number of days to file, and where to file as outlined in each of the specific Plans
- Maintains operations by following policies and procedures according to DOL and HIPAA regulations
- Maintains customer confidence and protects operations by keeping information confidential
- Provides the very best customer service to claimants, customers, providers of service and internal personnel concerning appeal reviews
- Communicates with appropriate parties regarding appeals issues, implications and decisions
- Analyzes and identifies trends for appeals and may research and resolve written Department of Insurance complaints and complex or multi-issue provider complaints submitted by consumers and physicians/providers
Regardless of your role at UnitedHealthcare, the support you feel all around you will enable you to do what you do with energy, integrity, and confidence. So take the first step in what is sure to be a fast paced and highly diversified career. Qualifications Qualifications:
- High school education or equivalent experience
- 2 years of Full Life Cycle Claims processing experience is required
- 2 years of Healthcare Appeals processing experience is required
- 2 year of MS Word, Excel is required
- Knowledge of Employer Group Plan Language is required
- MS Access is highly preferred
- Healthcare experience is highly preferred
- High level Oral and Written communication skills is required
- Production and quality standards must be met on a daily and monthly basis
Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.
Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V. UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. |
