UnitedHealth Group Audit Representative - Claims Quality - Taguig City, NCR in Taguig City, Philippines

Welcome to one of the toughest and most fulfilling ways to help people, including yourself.

We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement.

Join us and start doing your life's best work.(sm)Primary Responsibilities: Prevent the payment of potentially fraudulent and/or abusive claims utilizing medical expertise, knowledge of CPT/diagnosis codes, Centers for Medicare/Medicaid Services guidelines along with referring to client specific guidelines and member policiesIdentify diagnoses and procedures basis the CPT and diagnostics codes and medical records supplied by provider Review medical record documentation to identify under coded and up coded servicesResearch on provider data and member data to identify new or additional irregular billing patternsInterpret and analyze medical records as a mechanism for indexing medical information which is used for completion of statistics for hospital, regional and government planning and accurate hospital reimbursementReview of billing performances to ensure compliance with legal and procedural policies and to ensure optimal reimbursements while adhering to regulations prohibiting unbundling and other questionable practicesIdentify and abstract records consistently and accuratelyAssists with other ad hoc responsibilities deemed necessary by his/her supervisors Required Qualifications: Graduate and Board-passer (onetime take) of any Allied Medical Profession (Nurse, Physical/Occupational/Speech Therapist, Medical Technologist, etc.) with minimum 1 year of clinical/hospital experienceAAPC or AHIMA Certified or any equivalent coding certificationOne year of hands on experience on clinical reviewPassed all auditor assessmentPreferred Qualifications: Minimum 6 months Medical Coding experienceClaims processing experience in a BPO/HMO settingCareers with Optum.

Here's the idea.

We built an entire organization around one giant objective; make health care work better for everyone.

So when it comes to how we use the world’s large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve.

Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential.

For you, that means working on high performance teams against sophisticated challenges that matter.

Optum, incredible ideas in one incredible company and a singular opportunity to do your life’s best work.(sm) Diversity creates a healthier atmosphere: Optum is an Equal Employment Opportunity 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.

Optum is a drug-free workplace.

© 2017 Optum Global Solutions (Philippines) Inc.

All rights reserved. Job Keywords: Claims Quality, Audit Representative, Medical Coder, Medical Coding, Certified Professional Coder, Certified Medical Coder, Medical Coding Certification, Coding Certification, AAPC, AHIMA, CPC, Clinical, Hospital, Taguig City, NCR, National Capital Region 06cadab2-c201-47a1-8bea-b993057c8697

Audit Representative - Claims Quality - Taguig City, NCR Philippines-Taguig City 715678