Top 13 Investigative analyst Jobs in Minneapolis, Mn

M&R Coding Clinical Analyst
Optum —Plymouth, MN
- $24 - $43 an hour
- Full-time
- Remote
- Microsoft Excel
- Microsoft Outlook
- Computer literacy
10d
Professional Pre-Pay Medical Coding Auditor
Optum —Plymouth, MN
- $24 - $43 an hour
- Full-time
- Remote
- Microsoft Excel
- Microsoft Outlook
- Pass drug screening
7d
Risk Analyst , Relay Trust
Amazon.com Services LLC —Minneapolis, MN
- $55,600 - $97,400 a year
- Full-time
- Spanish
- Computer science
- Computer Science
- AD&D insurance
- Health insurance
Specialist, Risk and Compliance Services (Center of Excellence)
Deloitte —Minneapolis, MN
- $63,000 - $116,000 a year
- Full-time
- Microsoft Outlook
- Research
- Mid-level
12d
Threat Management Coordinator
Minnesota Judicial Branch —Saint Paul, MN
- $40.08 - $62.14 an hour
- Online Application
- Hybrid work
- 5 years
- Office
- Master's degree
- Paid parental leave
- Disability insurance
8d
Senior Data Analyst - TES Data and Analytics
Target —Brooklyn Park, MN
- $88,000 - $158,000 a year
- Full-time
- 5 years
- Office
- Analysis skills
- Paid holidays
- Disability insurance
6d
Supervisor Intelligence Analyst
City of Minneapolis —Minneapolis, MN
- $107,253 - $136,822 a year
- Overnight shift
- Background check
- Management
- 5 years
- Commuter assistance
- Paid parental leave
3d
Junior Compliance Officer (Operations, Junior Analyst)
The MIL Corporation —Saint Paul, MN
- $35,000 - $48,000 a year
- Overtime
- Bachelor of Science
- Research
- Finance
- Health insurance
- Tuition reimbursement
Affirmative Civil Enforcement (ACE) Investigator/Analyst
SGI Global, LLC —Minneapolis, MN
- Full-time
- Microsoft Access
- Microsoft Outlook
- Computer literacy
Quick Apply
Senior Analyst, Compliance
Thomson Reuters —Eagan, MN
- $74,200 - $158,700 a year
- Full-time
- Hybrid work
- Office
- Analysis skills
- Bachelor's degree
- Commuter assistance
- Health savings account
Senior Data Analyst - Remote
Optum —Eden Prairie, MN
- $91,700 - $163,700 a year
- Full-time
- Hybrid work
- Pass drug screening
- Office
- SQL
Quick Apply
19h
Community Safety Coordinator
People Serving People —Minneapolis, MN
- $27.50 an hour
- Full-time
- Microsoft Excel
- Microsoft Outlook
- Salesforce
- Commuter assistance
- Disability insurance
Quick Apply
19h
Lead AI/ML Engineer- Remote Nationwide or Hybrid in MN/DC
Optum —Eden Prairie, MN
- $145,500 - $249,500 a year
- Full-time
- Hybrid work
- Computer science
- Computer Science
- 5 years

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Professional Pre-Pay Medical Coding Auditor
Optum —Plymouth, MN
This could include Medical Director/physician consultations, interpretation of state and federal mandates, applicable benefit language, medical and…
$24 - $43 an hour
7d
Revenue Manager
Indian Health Board of Minneapolis —Minneapolis, MN
BA/BS in healthcare or related field, plus at least 5 years of claims billing experience with a health care provider or certification from NHA as a billing and…
$75,000 - $95,000 a year
Quick Apply

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investigative analyst jobs near minneapolis, mn

M&R Coding Clinical Analyst

Optum -
Plymouth, MN

Apply Now

Job Details

Full-time
$24 - $43 an hour
10 days ago

Qualifications

Microsoft Excel
Microsoft Outlook
High school diploma or GED
Health insurance knowledge
Clinical documentation standards
Medical terminology
Healthcare compliance
Documentation review

Full Job Description

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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

Remote: You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

The M&R Coding Clinical Analyst is required to determine the accuracy of claims submitted by a provider to UnitedHealth Group by comparing it to the medical record(s) submitted for the date(s) of service being reviewed. They must be able to exercise judgement/decision making on complex payment decisions that directly impacts the provider and UHC/Client by following state and government compliance guidelines, coding requirements and policies. They must confidently analyze and interpret data and medical records/documentation on a daily basis to understand historical claims activity, determine validity and demonstrate their ability to provide written communication to the provider. They are responsible to investigate, review and provide clinical and/or coding expertise in a review of pre-payment claims. They need to effectively manage their caseload and monthly metrics in a production driven environment and ensure they are meeting all compliance turnaround times mandated by the client. The Senior Recovery Resolution Analyst must be proficient in computer skills and able to navigate multiple systems at one time with varying levels of complexity. They must have the ability to research and work independently on making decisions on complex cases.

Responsibilities:

Performs quality audits of clinical review cases of CPT, HCPCS, and modifiers assigned to codes on claims in a telecommuting work environment
Determines accuracy of medical coding/billing and payment recommendation for pre-payment claims
This could include Medical Director/physician consultations, interpretation of state and federal mandates, applicable benefit language, medical and reimbursement policies and consideration of relevant clinical information
Determines appropriate level of service utilizing Evaluation and Management coding principles
Ensures adherence to state and federal compliance policies, reimbursement policies and contract compliance
Identifies aberrant billing patterns and trends, evidence of fraud, waste or abuse, and recommends providers to be flagged for review
Maintains and manages daily case review assignments, with accountability to quality, utilization and productivity standards
Provides clinical support and expertise to the other investigative and analytical areas
Participates in team and department meetings
Engages in a collaborative work environment when applicable but is also able to work independently
Serves as a clinical resource to other areas within the clinical investigative team
Work with applicable business partners to obtain additional information relevant to the clinical review

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 or GED
Certified Coder AHIMA or AAPC Certified coder (CPC, CCS, CCS-P ) or Nurse (RN, LPN) with unrestricted and active license/certification with medical record auditing and coding/billing experience
2+ years of experience as a AHIMA or AAPC Certified coder with 2+ years of CPT/HCPCS/ICD/Modifiers - 10/CM/PCS coding experience or Licensed nurse with medical record auditing and coding/billing experience
2+ years of experience with health insurance business, industry terminology, and regulatory guidelines
1+ year of working in a team atmosphere in a metric driven environment including; daily production standards and quality standards
Intermediate level of experience with medical record review
Intermediate computer skills with the ability to troubleshoot problems
Basic experience with Microsoft & Adobe applications (outlook, power point, word, excel, pdf)

Preferred Qualifications:

Bachelor degree
Healthcare claims experience/processing experience
Strong communication skills with the ability to interpret data
Experience with Fraud Waste & Abuse or Payment Integrity
Experience with subsequent or reconsideration reviews for FWAE
Strong analytical mindset working with medical terminology or coding
[Internal Posting Only] 1+ year experience of UHC platforms - COSMOS, Facets, CPW, NICE

Soft Skills:

Physical Requirements and Work Environment: frequent speaking, listening using headset, sitting, use of hands/fingers across keyboard
Must be proficient and able to navigate and maneuver multiple systems at one time with varying levels of complexity
All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $24.00 to $43.00 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

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.

#RPO, #GREEN

Apply Now

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investigative analyst jobs in minneapolis, mn

M&R Coding Clinical Analyst

Professional Pre-Pay Medical Coding Auditor

Risk Analyst , Relay Trust

Specialist, Risk and Compliance Services (Center of Excellence)

Threat Management Coordinator

Senior Data Analyst - TES Data and Analytics

Supervisor Intelligence Analyst

Junior Compliance Officer (Operations, Junior Analyst)

Affirmative Civil Enforcement (ACE) Investigator/Analyst

Senior Analyst, Compliance

Senior Data Analyst - Remote

Community Safety Coordinator

Lead AI/ML Engineer- Remote Nationwide or Hybrid in MN/DC

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