Responsible for assisting the Compliance Specialists in the preparation of documentation for health plan audits by responding to data requests from health plans and performing necessary data analysis in support of compliance activities.
Consistently exhibits behavior and communication skills that demonstrate HealthCare Partners’ (HCP) commitment to superior customer service, including quality, care and concern with each and every internal and external customer.
Supports compliance activities related to identifying, building and analyzing qualitative and quantitative data.
Supports the preparation for health plan audits and data requests from health plans.
Assists in the preparation of reports necessary to support health plan audits.
Reviews and analyzes claim selections sent from health plans via electronic report for appropriate audit categorization. i.e. Contracted, Non-contracted, Adjusted, Paid, Member Liability.
Prepares documents for each audit category by compiling and collating claims, referrals and EOB docs from IDX and check history (HCP internal web application - "Cleared Checks").
Reviews and verifies adjusted claims for appropriate backouts in IDX.
Reviews claims in Denial Letter System for appropriate determination of denial letter type-prints and mails letters to members and providers.
Validates termed health plan eligibility in IDX with HCP Eligibility Department and / or health plan to determine appropriate forwarding of denied claim.
Uses, protects, and discloses HCP patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.
Performs additional duties as assigned.
High school diploma, G.E.D. or equivalent. Includes special certification required for specific jobs.
Over 1 year and up to and including 3 years of experience.
KNOWLEDGE, SKILLS, ABILITIES:
Familiarity with Microsoft Office products
Excellent organizational and interpersonal skills.
Strong analytical and problem solving skills.
Knowledge of medical terminology and pricing options.
Familiarity with ICD-9 and CPT codes.
Ability to work in a team environment as well as independently.
Ability to organize work assignments and manage time effectively.
What's the first thing that happens when one of the leading independent medical groups in the country comes together with a global leader in health care? Opportunity. With DaVita Medical Group, HealthCare Partners, The Everett Clinic, Northwest Physicians Network, MountainView Medical Group and Magan Medical Clinic joining OptumCare and the UnitedHealth Group family of companies, people like you will find increasing levels of challenge, impact and professional success. We're changing health care for the better by improving access to affordable, high quality care, and working together to improve the patient experience. That takes passion, commitment, intense focus and the ability to contribute effectively in a highly collaborative team environment. Are you with us? Learn more about this exciting opportunity to do your life's best work.(SM)
Careers with OptumCare. 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. OptumCare, part of the UnitedHealth Group 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. Here you’ll find incredible ideas in one incredible company and a singular opportunity to do your life's best work.(SM)
Diversity creates a healthier atmosphere: OptumCare and its affiliated medical practices are Equal Employment Opportunity/Affirmative Action employers 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. OptumCare and its affiliated medical practices is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.