Hospital Charge Audit Eligibility Analyst - National Remote

You’ll enjoy the flexibility to telecommute from anywhere within the U.S. as you take on some tough challenges.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 diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.The H ospital Charge Audit Support – Eligibility Analyst position is a member of the Post-Pay Eligibility (PPE) group within the Hospital Charge Audit team and supports our auditors and audit process. The primary responsibility of the role is the perform pre-audit and post-audit analysis of claims and client contract information.This position is full-time (40 hours/week) Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of (7:00am - 4:00pm). It may be necessary, given the business need, to work occasional overtime.We offer weeks of on-the-job training. The hours of the training will be aligned with your schedule.All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.Primary Responsibilities:

Utilize Payer claim systems to review and analyze claims to verify eligibility and determine the payment methodology, exclusions, and non-covered charges

Screen clients' online systems for published changes such as new, modified and/or updated contracts/agreements/amendments and fee schedule

Complete client compliance training and maintain access to client systems

Research and respond to refund recovery team inquiries and/or other operational inquiries

Provide feedback on claims received that are not paying percent of charge for review by the Contract team

Review existing processes and suggest improvements

Other duties as assigned

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

3+ years of experience in medical claim processing, review and/or contract analysis

Ability to interpret client-provider contracts and extract necessary information to support the audit process

Understanding of payment methodology and the ability to calculate correct payment amounts for claims including, but not limited to: Per diem, stop loss, percent of charge, case rate

Proficient computer skills including Microsoft Office suite; Microsoft Word (ability to create, copy, edit, save and send documents), Microsoft Excel (ability to create, copy, edit, save and send spreadsheets) and Microsoft Outlook (email and calendar management)

Must be 18 years of age OR older

Ability to work any of our 8-hour shift schedules during our normal business hours of 7:00am - 4:00pm, Monday - Friday. It may be necessary, given the business need, to work occasional overtime.

Telecommuting Requirements:

Ability to keep all company sensitive documents secure (if applicable)

Required to have a dedicated work area established that is separated from other living areas and provides information privacy.

Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service.

Soft Skills:

Requires attention to detail, organizational, problem solving and time management skills with flexibility to adjust to changing priorities

Effective oral and written communication skills plus the ability to develop effective relationships with our internal and external customers

Must be self-directed and be able to accomplish work with limited supervision and general work direction

Confidence in ability to make decisions and support those decisions

California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Washington or Rhode Island Residents Only: The hourly range for California / Colorado / Connecticut / Hawaii / Nevada / New York / New Jersey / Washington / Rhode Island residents is $16.54 - $32.55 per hour. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.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