Audit and Recovery Analyst- Remote Job Northern Kentucky USA,Healthcare

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.

The Audit & Recovery Analyst position is to participate with the audit and recovery team in the timely implementation and completion of audit initiatives, and the related activities. Analyze, evaluate, and perform timely audits based on Optum policies and consistent with the nationally published guidelines regarding procedural documentation. Address provider calls regarding the audit process. Strong decision-making skills involving medical record documentation and minimum medical record documentation requirements.

You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

Maintain understanding of procedural codes and the documentation required to verify services and substantiate payment
Assist in the development and implementation audit and the related activities including printing and preparing letters requesting medical records, completion of the prepared audits and processing and completing appeals of adverse determinations of payment
Performs other projects, tasks and duties as assigned by management, professional committees and/or facilitate said processes
Ability to interface with supporting departments regarding the implementation of audit and recovery issues such as committee activities, appeals and changes in clinical submission
Participation in policy development
Be able to field questions from providers regarding the purpose and right of Optum Physical Health Solutions in conducting medical records audit
Ability to solve problems and deal with a variety of specific variations in situations where only limited standardization exists
Become familiar with the interaction with ODAR and completing the appeals of over payment determinations
Demonstrate effective written and oral communication skills
Maintain positive and productive relationships with provider community, clinical staff, and all other personnel
Accurately record all verbal communications with providers into communication log database
Ability to interact with audit and recovery staff in the completion of audit related activities
Ability to effectively present information and respond to questions from providers, audit and recovery staff, management, and other employees
Working knowledge of various software applications to perform the requirements of the position

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:

Undergraduate degree in specialized Physical medicine from an accredited college or university
Current Licensed or Certified Physical Therapist or Chiropractor with state-licensing agency

Preferred Qualifications:

Clinical practice experience
Thorough detailed working knowledge of procedural coding and the required supporting documentation
Proven solid decision‑making skills involving clinical and administrative data

* All employees working remotely will be required to adhere to United Health Group's Telecommuter Policy

Pay is based on several factors including but not…