AMS-FACS Support Triage - National Remote

Job title: AMS-FACS Support Triage - National Remote in Dallas, TX at UnitedHealth Group
Company: UnitedHealth Group
Job description: UMR, UnitedHealthcare’s third-party administrator (TPA) solution, is the nation’s largest TPA. When you work with UMR, what you do matters. It's that simple . . . and it's that rewarding.In providing consumer - oriented health benefit plans to millions of people; our goal is to create higher quality care, lower costs and greater access to health care. Join us and you will be empowered to achieve new levels of excellence and make a profound and personal impact as you contribute to new innovations in a vital and complex system. Opportunities are endless for your career development and advancement within UMR due to our record-breaking growth.Regardless of your role at UMR, the support you feel all around you will enable you to do what you do with energy, quality, and confidence. So, take the first step in what is sure to be a fast - paced and highly diversified career.In this role, you'll help drive cost containment and compliance by reviewing and documenting coding and billing issues, managing claims and provider disputes, supporting education efforts, and enhancing efficiency through automation and collaboration in a fast-paced environment.This position is full-time (40 hours / week), Monday - Friday. Employees are required to have the flexibility to work an 8-hour shift between 6:00am – 8:00pm their time. It may be necessary, given the business need, to work occasional overtime.You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.Primary Responsibilities:

• Analyze claims and data using a customized payment integrity dashboard.
• Establish, triage, and manage case inventory within a SharePoint environment.
• Coordinate the routing and processing of claims following completed reviews.
• Support provider education initiatives and outreach.
• Execute Pend and SharePoint macros to streamline workflow automation.
• Triage and manage provider and member dispute cases.
• Generate and prepare FWA (Fraud, Waste, and Abuse) script reports for the Special Investigations Unit (SIU).
• Request, track, and follow up on medical or case records.
• Monitor and verify receipt of requested documentation.
• Perform additional duties as assigned.
• Serve as a subject matter resource and support for team members.

You’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:

• High School Diploma / GED OR equivalent work experience
• Must be 18 years of age or older
• 1+ years of experience analyzing and solving customer problems
• Experience with medical claims billing (ICD-10 diagnoses, CPTs, and HCPCS codes)
• Experience with using Microsoft Word, Microsoft Excel, and Microsoft Outlook (ability to create, edit, copy, send, and save documents, spreadsheets, and correspondence)
• Ability to work full-time (40 hours / week), Monday - Friday. Employees are required to have the flexibility to work an 8-hour shift between 6:00am – 8:00pm their time. It may be necessary, given the business need, to work occasional overtime.

Preferred Qualifications:

• 1+ years of experience processing claims in UMR CPS / Jacada (UMR is UnitedHealthcare's third - party administrator (TPA) solution and candidate must be a previous OR current employee of UMR / UHSS specifically to have the required experience with the UMR CPS system) including experience with complex claim processing and adjustments
• Experience with UMR Policies and Procedures
• Experience supporting projects

Telecommuting Requirements:

• Ability to keep all company sensitive documents secure (if applicable)
• Required to have a dedicated work area established that is separated from other living areas and provides information privacy.
• Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service.

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter PolicyThe hourly range for this role is $16.88 to $33.22 per hour based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. 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.Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location, and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.#RPO
Expected salary: $16.88 - 33.22 per hour
Location: Dallas, TX
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