Recovery Resolution Consultant

Improve the lives of others while Caring. Connecting. Growing together.

Job Description - Recovery Resolution Consultant (2393163)

Recovery Resolution Consultant (

This position is National Remote. You’ll enjoy the flexibility to telecommute
* from anywhere within the U.S. as you take on some tough challenges.

Optum Insight is improving the flow of health data and information to create a more connected system. We remove friction and drive alignment between care providers and payers, and ultimately consumers. Our deep expertise in the industry and innovative technology empower us to help organizations reduce costs while improving risk management, quality and revenue growth. Ready to help us deliver results that improve lives?

Join us to start Caring. Connecting. Growing together.

This position is full-time Monday
- Friday. Employees are required to have flexibility to work any of our shift schedules during our normal business hours of 8am - 5pm.

This will be on the job training and the hours during training will be during normal business hours.

Primary Responsibilities:

• Provide assistance, give feedback, and request action in completing daily and monthly reporting, i.e. (Quality, Automation, Platforms)
• Aid in writing and implementing process improvement ideas, processes, i.e., Process mapping, job aids, PNP (Policies and Procedures)
• Create and present on - going development and educational training for production staff
• Aid with daily inventory management, task assignment and ensure escalations are responded to timely
• Be responsible for responding to complex coding case related questions placed on the SME/MD portal
• Responsible for supporting quality metric activities, including but not limited to the monthly questions for Quality Knowledge Test, enrollment and attend meetings as required
• Provide detailed research on claims and complex coding cases that require research
• Provide feedback/support for client and/or senior leadership meetings/presentations that include gathering key data/information and updating of forms/materials
• Work with OGA and OPRO teams to ensure consistent processes and claim resolution
• Assist internal teams with subject matter expertise such as appeals, QA, Second Set of Eyes, True Positive Rate Re-review, training, Root Cause, Clinical Program Optimization, Issue Resolution, PIRT and provider escalation teams
• Be point of contact and perform administrative duties when the manager is out
• Be available for questions via team chats and/or emails, provide coaching when employees need additional support
• Own and be accountable in the creation, development, and upkeep of Clinical team job aids to ensure the information is consistent and up to date
• Responsible for creating and facilitating bi-weekly team huddles agenda topics and education
• Participate in overarching organizations meetings i.e. (Town Halls, Manager meetings, Monthly Leadership Connect, leader Link Series)
• Attend and provide feedback for meetings that impact business operations, i.e. (Management of Change, Work Force Management, Automations, Projects, Change Advisory Board, R&D/Ideation)
• Other duties/Projects as assigned by leadership

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
• Certified Coder AHIMA OR AAPC Certified coder (CPC, CCS, CCA,)
• Must be 18 years of age OR older
• 2+ years of experience as an AHIMA or AAPC Certified coder
• Understanding of Fraud, Waste, Abuse and Error principles and health insurance experience
• Knowledge of health insurance business, industry terminology,…