Conduct MS DRG and APR DRG coding reviews to verify the accuracy of DRG assignment and reimbursement with a focus on overpayment identification Expert knowledge of and the ability to identify the ICD 10 CM/PCS code assignment, appropriate code sequencing, present on admission (POA) assignment, and discharge disposition, in accordance with CMS requirements, ICD 10 Official

Demonstrates solid collaboration skills and a service excellence / servant leadership mentality Lives and incorporates the UHG values in their daily work Demonstrates history of delivering value with strategic pharmaceutical categories Forms high performance relationships with Care Delivery Organizations, enterprise teams, subject experts, and suppliers Demonstrates excep

Demonstrates solid collaboration skills and a service excellence / servant leadership mentality Lives and incorporates the UHG values in their daily work Demonstrates history of delivering value with strategic clinical services/indirect categories Forms high performance relationships with Care Delivery Organizations, enterprise teams, subject experts and suppliers Demonst

Design, develop and implement analytics rules engines Research, evaluate, and deploy new tools, frameworks, and patterns to build sustainable Big Data platform Identify gaps and opportunities for improvement of existing solutions Define and develop APIs for integration with various data sources in the enterprise Analyze and define customer requirements Assist in defining

Monitor Daily EDI Transaction Processing Troubleshoot and Resolve any EDI processing issues Implementation Team Resource for EDI Mapping, Validation and Testing as required Prepare and update program documentation, job aides, and other artifacts as requested Scheduled and ad hoc auditing of various systems and databases to support prior authorization transactions Process

Perform coding compliance and quality audits in support of Optum Insight Provider's Compliance Program and client expectations Analyze and interpret documentation from medical records Clearly document audit findings and calculate billing error rates Provide feedback and education as appropriate depending on findings Articulate audit findings appropriate to the audience Pr

Perform coding compliance and quality audits in support of Optum Insight Provider's Compliance Program and client expectations Analyze and interpret documentation from medical records Clearly document audit findings and calculate billing error rates Provide feedback and education as appropriate depending on findings Articulate audit findings appropriate to the audience Pr

Responsible for completing the financial clearance process and creating the first impression of Optum services to patients, their families, and other external customers. You will articulate information in a manner that patients, guarantors, and family members understand and will know what to expect regarding their financial responsibilities. Work with medical staff, nursi

Provide superior analytic consultation with a focus on client satisfaction, client retention, and trend management Support short and long term operational and strategic business activities Design, execute, and maintain advanced PBM analytics, conduct and evaluate trend analyses, and present clinical and financial opportunities based on analytic insights to clients Use log

Perform financial clearance processes by interviewing patients and collecting and recording all necessary information for pre registration of patients Educate patients of pertinent policies as necessary i.e., Patient Rights, HIPAA information, consents for treatment, visiting hours, etc. Verify insurance eligibility and completes automated insurance eligibility verificati

Maintain general ledger accounts and related activities for the production of financial statements and reports Reconcile, analyze and review general ledger accounts in preparation for month end close Analyze and prepare financial statements, including balance sheets and statements of financial position Assist with or lead the month end quarterly end close process for assi

Extract, analyze, aggregate, and interpret data Perform quantitative analysis of health care claims utilization and cost data Participate in client relationships and communications Prepare information for clients, build reports, and assist with project scheduling and coordination of tasks Develop, review, and analyze detailed data sets leveraged for client reporting/analy

Perform an individual billable role for clients, contributing to the daily delivery of a large scale and highly complex process Support cross business analytics (Commercial, Medicare, & Medicaid) in the development of consistent and appropriate modeling Lead meetings and present analytic findings across actuarial and non actuarial stakeholders Collaborate with key stakeho

Greets and welcomes patient in person Collects demographic and insurance information Checks in or interviews patient to complete appropriate paperwork Directs patient to their appointment or procedure May assist in scheduling add on appointments Verifies eligibility and benefits information for payers and interprets results Obtains signatures from patients as needed Colle

Collects demographic and insurance information Documents any issues and resolutions in electronic medical record Uses resources, tools and procedures to complete registration for complex accounts Verifies eligibility and benefits information for payers and interprets results focusing on complex billing situations Obtains cost information and explains information to patien