Appeals Coordinator Eden Prairie, MN
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POST DATE 8/5/2020
END DATE 8/6/2020
Eden Prairie, MN
JOB DESCRIPTIONWelcome 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.
Let s talk about diplomacy. Let s talk about accuracy. Let s talk about how UNITEDHEALTH GROUP became a Fortune 6 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 6 leader.
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.
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. .
* Research and resolve written appeals submitted by consumers and physicians / providers
* Ensure appeals has been categorized correctly
* Obtain additional documentation required for case review
* Review case to determine if review by clinician is required
* Render decision for non - clinical appeals using sound, fact - based decision making
* Complete necessary documentation of final appeals or grievance determination using appropriate templates
* Communicate appeal or grievance information to members or providers and internal / external parties within the required timeframes
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.
* High School Diploma / GED (or higher) or equivalent work experience
* 1+ years of experience analyzing and solving customer problems OR 1+ year of work experience in a related environment (i.e. office, administrative, clerical, customer service, etc.) using phones and computers as the primary job tool
* Proficiency with computers and Windows PC applications, which includes the ability to navigate and learn new and complex computer system applications
* Bachelor s Degree (or higher)
* Experience with health care, medical, or pharmacy terminology
* Experience working with healthcare insurance industry
* Experience working with Healthcare Appeal cases
* Strong written and verbal communication skills including advanced skills in grammar and spelling
UNITEDHEALTH GROUP is working to create the Healthcare system of tomorrow and you can help. Already Fortune 6, we are totally focused on innovation and change. We work a little harder. We aim a little higher. We expect more from ourselves and each other. And at the end of the day, we're doing a lot of good.
Through our family of businesses and a lot of inspired individuals, we're building a high - performance Healthcare system that works better for more people in more ways than ever. Now we're looking to reinforce our team with people who are decisive, brilliant and built for speed. Join with us and start doing 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.
Keywords: Healthcare, health care, Managed Care, Appeals, Billing Representative, Billing, Collections, Claims, Customer Service, Medical Billing
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