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.(sm)

Optum’s Pacific West region is redefining health care with a focus on health equity, affordability, quality, and convenience. From California to Oregon and Washington, we are focused on helping more than 2.5 million patients live healthier lives and helping the health system work better for everyone. At Optum Pacific West, we care. We care for our team members, our patients, and our communities. Join our culture of caring and make a positive and lasting impact on health care for millions.

General Role Description: The Compliance Review Coordinator processes functions including investigations, negotiating settlements, payments, research regarding eligibility, etc in a timely and accurate manner in alignment with regulatory requirements.

Primary Responsibilities:

• Research, identify and obtain data/information needed to help process claims or resolve claims issues (e.g., verify pricing, prior authorizations, applicable benefits)
• Ensure that proper benefits are applied to every claim
• Apply knowledge of customer service and applicable law requirements to process claims appropriately (e.g., Service Level Agreements, performance guarantees). Identify and apply knowledge of new plans/customers to process their claims appropriately
• Identify and resolve claims processing errors/issues and trends, as needed (e.g., related to system configuration, network, eligibility, data accuracy, vendor-related, provider)
• Resolve or address new or unusual claims errors/issues as they arise, applying appropriate knowledge or prior experience
• Prepare, distribute, monitor, and review various daily reports for management for compliance
• Communicate and collaborate with external stakeholders (e.g., members, family members, providers, vendors) to resolve claims errors/issues, using clear, simple language to ensure understanding
• Collaborate with internal business partners to resolve claims errors/issues (e.g., Subject Matter Experts, Network Management, IT/systems staff, Compliance, vendor management teams, contract teams)
• Document and communicate status of claims/investigations to stakeholders as needed, adhering to reporting requirements (e.g., status letters/reports)
• Achieve applicable performance metrics (e.g., productivity, quality, TAT)
  

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 Qualification:

• High school diploma or GED or equivalent experience
  

Preferred Qualifications:

• Associates degree (A.A.) or equivalent from two-year college or technical school
• 1+ years related experience and/or training with an understanding of health plans, health plan eligibility and health care benefits, or equivalent combination of education and experience
• General knowledge of Correct Coding Initiative, HCFA-1500 and UB-92 claim forms, and CPT Coding
  

Careers at OptumCare. We're on a mission to change the face of health care. As the largest health and wellness business in the US, we help 58 million people navigate the health care system, finance their health care needs and achieve their health and well-being goals. Fortunately, we have a team of the best and brightest minds on the planet to make it happen. Together we're creating the most innovative ideas and comprehensive strategies to help heal the health care system and create a brighter future for us all. Join us and learn why there is no better place to do your life's best work.(sm)

OptumCare is committed to creating an environment where physicians focus on what they do best: care for their patients. To do so, OptumCare provides administrative and business support services to both owned and affiliated medical practices which are part of OptumCare. Each medical practice part and their physician employees have complete authority with regards to all medical decision-making and patient care. OptumCare’s support services do not interfere with or control the practice of medicine by the medical practices or any of their physicians.

California Residents Only: The hourly range for California residents is $16.00 to $27.31. 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.

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.




Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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.

OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.