Sr Clinical Informatics Consult - Telecommute
Company: UnitedHealth Group
Location: Draper
Posted on: June 19, 2022
Job Description:
Combine two of the fastest-growing fields on the planet with a
culture of performance, collaboration and opportunity and this is
what you get. Leading edge technology in an industry that's
improving the lives of millions. Here, innovation isn't about
another gadget, it's about making health care data available
wherever and whenever people need it, safely and reliably. There's
no room for error. Join us and start doing your life's best
work.(sm)You'll enjoy the flexibility to telecommute* from anywhere
within the U.S. as you take on some tough challenges.Primary
Responsibilities:
- Conduct clinical root cause analysis of both facility &
professional charts and claim payment decisions to fine tune the
natural language processing and machine learning model of the
product referenced above
- Apply clinical knowledge in the interpretation of medical
policy, resource utilization, and benefit document language in the
review of professional and facility pre-pay and post-pay clinical
audits
- Collaborate with multidisciplinary teams on complex and
challenging problems
- Create education for providers and payers on clinical and
coding situations in pursuit of accurate billing and payment
practices
- Actively participate in regular meetings and projects focused
on clinical and coding decision-making, clinical resource
utilization, clinical analytics development and interpretation,
payer cost savings, and staff training
- Participate in the interpretation of medical guidelines and
payment policies to create parameters for clinical reviews of
facility pre- and post- pay claims
- Assist with level clinical reviews and train other clinicians
to perform reviews
- Translate complex clinical concepts in ways that can be
understood by a variety of audiences
- Influence senior leadership to adopt new ideas, products,
and/or approaches
- Other duties as assignedYou'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 applicable area of expertise or
equivalent experience
- Current, active, and fully non-restricted licensed
Clinician
- Coding Certification thru AHIMA (CCS, CDIS, RHIA, RHIT) or AAPC
(CIC)
- 5+ years of clinical practice experience
- 5+ years of CPT/HCPCS/ICD-9/ICD-10 coding experience with a
thorough knowledge of health insurance business, including
knowledge of industry terminology and regulatory guidelines
- 3+ years in facility DRG and Clinical Validation Audit
reviews
- 2+ years' experience in leading clinical operations within a
health plan/or managed care environment to include client facing
experiencePreferred Qualifications:
- Experience with Encoder and Grouper Software (Optum and
3M)
- Experience working with multidisciplinary team/business units
across Business Operations (1st Review, Appeals)
- Experience in driving quality process improvement
- Experience -with analytics team
- Proven success in the ability to define, ascertain, and
organize complex data to determine root cause issues and
recommended solutions
- Proven ability to successfully manage projects across various
departments for business solutioning
- Knowledge of federal (e.g., CMS) and state laws and
regulationsCritical Success Factors:
- The ability to translate your solid, diverse clinical knowledge
to solve critical business problems on multidisciplinary teams
- Ability to aggregate and analyze data from multiple sources and
synthesize solutions for complex clinical and business
problems
- Ability to apply processes, skills, knowledge, and experience
to achieve specific project objectives within agreed parameters of
time and budget
- Ability to lead, manage others, and deliver on project goals on
time, in budget, in a fast-paced environment where change is the
only thing that is constant
- Ability to foster communications, robust collaboration, and
solid partnerships among providers, clients, leaders, and
teams
- Solid understanding of Coding, Payer Payment Policies and
Fraud, Waste, Abuse, and Error methodologies
- Excellent verbal and written communications skills
- Solid team player with team building skills
- Solid negotiation and conflict management skills
- Solid problem-solving, negotiation and persuasion skills
- Familiarity with current medical issues and practices
- Develops pioneering approaches to emerging industry trendsTo
protect the health and safety of our workforce, patients and
communities we serve, UnitedHealth Group and its affiliate
companies require all employees to disclose COVID-19 vaccination
status prior to beginning employment. In addition, some roles and
locations require full COVID-19 vaccination, including boosters, as
an essential job function. UnitedHealth Group adheres to all
federal, state and local COVID-19 vaccination regulations as well
as all client COVID-19 vaccination requirements and will obtain the
necessary information from candidates prior to employment to ensure
compliance. Candidates must be able to perform all essential job
functions with or without reasonable accommodation. Failure to meet
the vaccination requirement may result in rescission of an
employment offer or termination of employmentCareers with Optum.
Here's the idea. We built an entire organization around one giant
objective; make health care work better for everyone. So when it
comes to how we use the world's large accumulation of
health-related information, or guide health and lifestyle choices
or manage pharmacy benefits for millions, our first goal is to leap
beyond the status quo and uncover new ways to serve. Optum, part of
the UnitedHealth Group family of businesses, brings together some
of the greatest minds and most advanced ideas on where health care
has to go in order to reach its fullest potential. For you, that
means working on high performance teams against sophisticated
challenges that matter. Optum, incredible ideas in one incredible
company and a singular opportunity to do your life's best
work.(sm)*All Telecommuters will be required to adhere to
UnitedHealth Group's Telecommuter Policy.Colorado, Connecticut or
Nevada Residents Only: The Salary -range for Colorado Connecticut
and Nevada residents is -$97,300 to 176,900. -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. -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. - - -
Keywords: UnitedHealth Group, Draper , Sr Clinical Informatics Consult - Telecommute, Accounting, Auditing , Draper, Utah
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