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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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