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Prepay Commercial Facility Clinical Investigator - US Telecommute or Eden Prairie MN

Tampa, FL

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Welcome 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.SM The PrePay Commercial Facility Clinical 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.Positions in this function are responsible for investigating, recovering and resolving all types of claims as well as recovery and resolution for health plans, commercial customers and government entities.May include initiating telephone calls to members, providers and other insurance companies to gather coordination of benefits data.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.May conduct contestable investigations to review medical history.May monitor large claims including transplant cases. Primary Responsibilities: Examine, assess, and document business operations and procedures to ensure data integrity, data security and process optimization.nInvestigate, recover, and resolve all types of claims as well as recovery and resolution for health plans, commercial customers, and government entities nInvestigate and pursue recoveries and payables on subrogation claims and file management nInitiate phone calls to members, providers, and other insurance companies to gather coordination of benefits informationnProcess recovery on claims nEnsure adherence to state and federal compliance policies, reimbursement policies, and contract compliance nUse pertinent data and facts to identify and solve a range of problems within area of expertise nGenerally work is self-directed and not prescribed.nWorks with less structured, more complex issues.nServes as a resource to others.Requirements: Associate Degree (or higher) or a High School diploma/GED with 2 years of claims auditing experience nAn unrestricted RN or LVN or LPN license OR a current certified coder including RHIT n1 year of experience analyzing data and identifying cost saving opportunities n2 years current CPT/HCPCS/ICD-10 coding experience (entering codes, auditing etc.) nKnowledge of claims processing systems and guidelines/processes nPreferred Requirements: nExperience with MS Excel - sorting, formulas, creating and editing spreadsheets nExperience with Microsoft systems (Outlook - update calendar, set out of office, create signatures, send emails; Word - create/edit documents, work with templates; PowerPoint - create and present presentations)nPhysical Requirements and Work Environment: Frequentu00a0sitting, use of hands/fingers across keyboard or mouse, long periods working at a computernService center environment with moderate noise level due to Representatives talking, computers, printers, and floor activitynCareers 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 **MEMBERS ONLY**SIGN UP NOW***. 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.SMnDiversity creates a healthier atmosphere: **MEMBERS ONLY**SIGN UP NOW***. 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.**MEMBERS ONLY**SIGN UP NOW***. is a drug-free workplace.Candidates are required to pass a drug test before beginning employment. Keywords: Optum, investigator, medical records, pre pay, commercial, facility, clinical

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