Perform quality review of Medicare coverage determinations and cancel cases to determine the following 1) accuracy of review 2) timeliness 3) correctness of authorization placement 4) compliance errors 5) Adherence to Clinical Policies and Procedures Navigate multiple computer programs to review and document the accuracy of case reviews, report errors and remediate as dir

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

Lead a high performing, multi disciplinary global engineering team of 50+ engineers across web, mobile and portal solutions Define the digital technology strategy for the common component and Patient facing digital experiences, driving substantial reuse of code, designs, and architecture across UHG Formulate and lead both near term and long term digital product developmen

Pricing support for OptumInsight Payer software and services product suite Pull and manipulate operational and financial data Maintain and enhance pricing models and templates Effectively work with cross functional teams that include Finance, Sales, Product and Operations Develop a strong understanding of the business mission through effective interactions with upper mana

Oversee detailed data analytics and financial projections (e.g., MicroStrategy, Excel) and translate findings to operational stakeholders Perform project / program management activities, such as monitoring client scope, creating and tracking deliverables, creating status reports, identifying and mitigating risks, managing resource plans, and monitoring successful achievem

Design and develop maintain scalable and efficient software applications to meet business requirements Utilize programming languages including but not limited to Javascript, C#, Python, SQL to write clean and efficient code Apply analytics to large data sets using statistical empirical frameworks Solve business problems and optimize processes with well thought out solutio

IT Pillar financial responsibilities spanning across multiple long term MPP clients totaling billions of dollars in TCV Scaling financial operations related to IT Delivery across MPP clients Monitoring of financial spend in comparison to contract to ensure that no financial leakage occurs Work with operational leaders to monitor financial performance compared to deal pro

Help process provider credentialing and enrollment applications and re applications including initial mailing, review and loading into the database tracking system Conduct audits and provide feedback to reduce errors and improve processes and performance Demonstrate great depth of knowledge/skills in own function and act as a technical resource to others Solve complex pro

Provide day to day administrative support with proven attention to detail and sound judgement in a timely manner consistent with the highest level of performance and professionalism Effectively communicate with C suite executives, their executive assistants and colleagues while building effective relationships and operating as a team player Management of the CEO's calenda

Identify appropriate assignment of ICD 10 CM and ICD 10 PCS Codes for inpatient services provided in a hospital setting and understand their impact on the DRG with reference to CC/MCC, while adhering to the official coding guidelines and established client coding guidelines of the assigned facility Identify appropriate assignment of CPT and ICD 10 Codes for outpatient sur

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

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 verificatio

Works on complex, major or highly visible tasks and projects as a project team member, sometimes as a project lead Expertise in multiple technical environments and possesses business knowledge that spans one or more business areas Participates in project planning processes Identifies project tasks and leads or assists with project timeline estimations Works with other tea

Identify appropriate assignment of ICD 10 CM and ICD 10 PCS Codes for inpatient services provided in a hospital setting and understand their impact on the DRG with reference to CC/MCC, while adhering to the official coding guidelines and established client coding guidelines of the assigned facility Identify appropriate assignment of CPT and ICD 10 Codes for outpatient sur

Perform remote and onsite hospital bill charge audits as assigned while meeting department quality expectations Manage case inventory to ensure timely scheduling of remote and onsite audits while maintaining weekly productivity goals Ability to assess case details and provide input into audit potential of facilities & cases Effectively interact and communicate with teamma