Physician Assistant, Medical Claim Review

4 weeks ago

Eden Prairie, United States UnitedHealth Group Full time

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

The Physician Assistant / Physician Associate is responsible for reviewing post-service claims for medical necessity for all inpatient and outpatient diagnoses.

You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

  • Work as part of an integrated team of medical director physicians, other physician assistants, and other members of the MCR staff
  • Perform individual case review for Medical Claim Review for various health plan and insurance products, which may include PPO, ASO, HMO, MAPD, and PDP. These claims may be in response to adverse determinations for medical services related to benefit design and coverage, medical necessity, and the application of clinical criteria of medical policies
  • Communicate with UHG medical directors regarding MCR decision rationales and benefit interpretations
  • Actively participate in team meetings focused on communication, feedback, problem solving, process improvement, staff training and evaluation, and the sharing of program results
  • Provide clinical and strategic input when participating in organizational committees, projects, and task forces

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:

  • Active, unrestricted Physician Assistant license
  • Board-certified by NCCPA
  • 8+ years of post-graduate, hands on clinical experience
  • 2+ years of experience in hospital-based medicine
  • Intermediate or higher level of proficiency with managed care (i.e., billing, coding)
  • Access to high-speed internet and a dedicated, distraction-free workspace at home

Preferred Qualifications:

  • 10+ years of experience in post-graduate, hands on clinical practice
  • 2+ years of experience in Quality Management
  • Experience with claims coding & review
  • Experience with managed care principles & utilization of evidence-based clinical criteria
  • Familiarity with current medical issues and practices
  • Proven data analysis and interpretation skills
  • Proven excellent telephonic communication skills; excellent interpersonal communication skills
  • Proven excellent project management skills
  • Proven excellent presentation skills for both clinical and non-clinical audiences
  • Proven creative problem-solving skills
  • Proven basic computer skills, typing, word processing, presentation, and spreadsheet applications skills
  • Proven internet researching skills
  • Proven solid team player and team building skills

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Rhode Island, or Washington Residents Only: The salary range for this role is $88,000 to $173,200 annually. 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.

Diversity creates a healthier atmosphere: UnitedHealth Group 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.

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

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