Appeals Analyst – Work From Home Job Vacancy in UnitedHealth Group Las Vegas, NV 89199 – Latest Jobs in Las Vegas, NV 89199

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Company Name : UnitedHealth Group
Location : Las Vegas, NV 89199
Position : Appeals Analyst – Work From Home

Job Description : If you are located within CST, MST, AZ, or PST, you will have the flexibility to telecommute* (work from home) as you take on some tough challenges.

Let’s talk about diplomacy. Let’s talk about accuracy. Let’s talk about how UnitedHealth Group became a Fortune 10 company leader in health care. We did it by working to become an undisputed leader in creating quality service and helping to improve the lives of millions. Now, here’s where you come in. You can build on your problem-solving skills by taking on responsibility for reviewing, researching, investigating and triaging claims that were denied to determine their correct status. You’ll drive the action and communicate with appropriate parties regarding appeals and grievance issues. In turn, we’ll provide you with the great training, support and opportunities you’d expect from a Fortune 10 company.
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.

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

Primary Responsibilities:

Researching and analyzing medical records to assist in the processing of appeal responses
Searching for documentation within medical records to allow / uphold prior adjustments on appeal
Acting as a departmental resource on appeals and resolution matters as required; performing research as warranted
Contributing to the development of resolution and appeals functions, including workflows, policies and procedures, staff training, and documentation.
Coordinate work for, and work with, Resolution & Appeals Claim Rep triaging medical records, setting up claim appeals in Optum Systems, and other duties to be determined.
Perform research and provide documentation for resolution and appeal matters as requested within required time frames
Update claims (logs, dates, processes, documentation) in Optum system in accordance with company standards within established time standards
Perform peer QA of appeal analyst reviews as-needed (back-up)
Participate in department and company meetings as requested
Participate on committees and special projects (as assigned or required) to ensure consistency of the claim review from the initial report through the appeal process
Meet time, quality, and customer satisfaction standards
Understand, maintain, and apply HIPAA, confidentiality, and privacy standards to assigned work, as well as ERISA and fraud, waste and abuse laws

This is a challenging role with serious impact. You’ll need strong analytical skills and the ability to effectively interact with other departments to obtain original claims processing details. You’ll also need to effectively draft correspondence that explains the claim resolution/outcome as well as next steps/actions for the member.
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)
3+ years of coding experience and/or 3+ years of experience in payer appeals processing
2+ years of progressive business experience, preferably in a healthcare or managed care administration environment
CPC (Certified Professional Coder) or CCS (Certified Coding Specialist)
Familiarity with appeal regulations, medical terminology, and coding
Familiarity with plan benefit, Medicaid and Medicare requirements
Proficiency in MS Office Suite, including Microsoft Word (creating, editing, saving, formatting) and Microsoft Excel (create and edit spreadsheets)
Research skills (to obtain information necessary for drafting appeal responses, claim resolution, state or federal requirements, and legal issues)
Ability to 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

Preferred Qualifications:

Associate’s Degree (or higher)
Experience in health law or regulatory field
LPN
RHIT (Registered Health Information technician) certification

Telecommuting Requirements:

Reside within CST, MST, AZ, or PST
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 verbal and written communication skills, with ability to multi-task and work with little direction
Strong organizational skills and attention to detail, as well as strong analytical skills and time management

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 https://uhg.hr/transitioning-military
Learn how Teresa, a Senior Quality Analyst, works with military veterans and ensures they receive the best benefits and experience possible. https://uhg.hr/vet
Colorado and Nevada Residents Only: The salary range for Colorado residents is $15.00 to $25.19. The salary range for Nevada residents is $15.77 to $27.79. 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
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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