Responsible for coordinating and triaging incoming provider dispute requests to ensure timely and accurate processing in alignment with regulatory requirements. Primary Responsibilities:Performs daily routine review, research and processing of paper and electronic provider disputes to identify appropriate workflow to support regulatory and compliance requirements within set timeframesCompletes a daily review of internal electronic submission of provider inquires and addresses each electronically submitted dispute by providing documented response to providersPrepares and bundles incoming provider disputes for daily submission to contracted vendor for electronic imaging. Performs routine self-audit to ensure accuracy of submissionsPrepares various daily reports for management using Access databasesAssists management by preparing documents for external health plan auditsMonitors, reviews, processes daily system generated reports to ensure timeliness and accurateness of provider disputesProvides written resolution determination to health plans and acts as liaison for health plan CAP deduction processMaintains and modifies documented standard operating procedures (SOP's)Maintains daily PDR, adjustment, and audit inventory reportsMaintains Compliance and Regulatory reporting libraryAssists in research and production of department tracking and trending reportsMaintains daily automated Acknowledgement and Resolution letter Microsoft mail merges. Performs routine audit on produced Acknowledgement and Resolution letters to ensure accuracyMaintains provider dispute filing system to ensure health plan and HIPAA compliancePerforms routine data entry and system edits to support Claims Resolution teamRegular and consistent attendance
Required Qualifications:High school education or equivalent experience1 year of related work experience, including:Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manualsAbility to write routine reports and correspondenceAbility to add, subtract, multiply, and divide all units of measure, using whole numbers, common fractions, and decimalsAbility to compute rate, ratio, and percent and to draw and interpret bar graphsAbility to apply commonsense understanding to carry out instructions furnished in written, oral, or diagram formAbility to deal with problems involving several concrete variables in standardized situationsProficient in Microsoft office (Word, Excel, Access)Ability to navigate the InternetPreferred Qualifications:EZ Cap experienceAbility to communicate effectively, both verbally and writtenDetail oriented and able to multi-task in a fast paced environmentSelf motivated What's the first thing that happens when one of the most successful physician groups in Orange County comes together with a global leader in health care? Opportunity. With Monarch HealthCare joining OptumCare and the UnitedHealth Group family of companies, people like you will find increasing levels of challenge, impact and professional success. With a vibrant network of hospitals and urgent care centers, we're changing health care for the better by improving access to affordable, high quality care, and working together to improve the patient experience. That takes passion, commitment, intense focus and the ability to contribute effectively in a highly collaborative team environment. Are you with us? Learn more about this exciting opportunity to do your life's best work.(sm) 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. Job Keywords: Document review, operating manual, safety, maintenance, reports, Irvine, CA, California
Our mission is to help people live healthier lives and to help make the health system work better for everyone.- We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities. - We work with health care professionals and other key partners to expand access to quality health care so people get the care they need... at an affordable price. - We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions.