(RN,LPN, or Certified Coder needed) Healthcare Compliance Auditor - Hybrid in Boston, MA
Company: UnitedHealth Group
Posted on: September 20, 2023
If you are located within Boston, MA, you will have the
flexibility to work from home and the office in this hybrid role*
as you take on some tough challenges.
Optum -is a global organization that delivers care, aided by
technology to help millions of people live healthier lives. The
work you do with our team will directly improve health outcomes by
connecting people with the care, pharmacy benefits, data, and
resources they need to feel their best. Here, you will find a
culture guided by diversity and inclusion, talented peers,
comprehensive benefits, and career development opportunities. Come
make an impact on the communities we serve as you help us advance
health equity on a global scale. Join us to start -Caring.
Connecting. Growing together.
The Healthcare Compliance Auditor -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, Monday - Friday. Employees are required
to work our normal business hours of 7:00am - 3:30pm or 8:00am -
4:30pm EST. -
Our office is located at 1325 Boylston St. Boston, MA. Employees
will be required to work some days onsite and some days from
*All Telecommuters will be required to adhere to UnitedHealth
Group's Telecommuter Policy.
- Examine, assess, and document business operations and
procedures to ensure data integrity, data security and process
- 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.
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
- High School Diploma / GED (or higher)
- 1+ years of experience analyzing data and identifying cost
- Knowledge of claims processing systems and guidelines.
- Intermediate skills with Microsoft Excel
- Experience in healthcare
- Ability to travel up to 25% within the state of
- Must be a Certified Coder, certified auditor, Certified RN, or
- Ability to work full-time, Monday - Friday. Employees are
required to work our normal business hours of 7:00am - 3:30pm or
8:00am - 4:30pm EST
- Associate's Degree (or higher)
- 1+ years of project management experience
- 2+ years of experience with claims auditing and researching
- Knowledge of Medicaid/Medicare Reimbursement
- Microsoft Access
- Experience working with medical claims platforms
- Reside -within the state of Massachusetts
- Required to have a dedicated work area established that is
separated from other living areas and provides information
- Ability to keep all company sensitive documents secure (if
- Must live in a location that can receive a UnitedHealth Group
approved high-speed internet connection or leverage an existing
high-speed internet service
Physical Requirements 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
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
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.
Keywords: UnitedHealth Group, Cambridge , (RN,LPN, or Certified Coder needed) Healthcare Compliance Auditor - Hybrid in Boston, MA, Healthcare , Cambridge, Massachusetts
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