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UnitedHealth Group

Clinical Appeals Reviewer - Telecommute (EST or CST Only)

UnitedHealth Group - Tampa, FL

Position Description Position Description:For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us and help people live healthier lives while doing your life's best work.Primary Responsibilities: Review Medical records for missing documentation and request missing documentation Set up case with all relevant documents, Medical records and benefit documents Responsible for managing appeal case load routed by the Senior Triage Specialist from the department Medical Management queue in the Escalation Tracking System (ETS) to the Triage Specialist's personal work queue in ETS Ability to identify the correct type of appeal and re-route correspondence determined not appropriate for processing within the department Appropriately and completely entering the appeal triage template into the Integrated Clinical User Experience (ICUE) and into ETS Required Qualifications: High School Diploma / GED (or higher) 1 years of experience working with Microsoft Word and PDF conversion (ability to convert documents) 1 years of Customer Service experiencePrevious experience working with Microsoft Office including Microsoft Outlook (ability to create, edit, save, and send documents) and Microsoft Excel (ability to create, edit, save, and send documents) Able to type at least 45-50 WPM accurately Must have a quiet designated secure work space and access to install secure high speed internet (minimum speed 1.5 download mps and 1 upload mps) via cable / DSL in home (NOTE: wireless / cell phone provider, satellite, microwave, etc... does NOT meet this requirement)Ability to work 8:00 am - 5:30 pm EST or CST schedule (Sunday - Thursday, Tuesday - Satruday, Saturday - Wednesday. Schedule will include at least one weekend shift)Preferred Qualifications: Some College Healthcare Claims experience Experience working in a Clinical, Hospital or Medical Office setting Knowledge of Medical Terminology and CPT / ICD-10 Coding Managed Care / Health Insurance experience Experience working in a Telecommute / Virtual environment Experience utilizing Macro Express or Macro Express Pro ICUE experience UNET experienceCareers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 6 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can do your life's best work.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: UHG, Telecommute, customer service, healthcare, telephonic, patient interaction, field based, advocacy

8 days 17 hours ago

UnitedHealth Group


Clinical Appeals Reviewer - Telecommute (EST or CST Only) UnitedHealth Group - Tampa, FL, United States


Location: Tampa, FL

Company Profile:
About UnitedHealth Group UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone. We are committed to introducing innovative approaches, products and services that can improve personal health and promote healthier populations in local communities. Our core capabilities in clinical care resources, information and technology uniquely enable us to meet the evolving needs of a changing health care environment as millions more Americans enter a structured system of health benefits and we help build a stronger, higher quality health system that is sustainable for the long term