Senior Claims Representative - Knoxville or Nashville, TN Job in Multiple locations

UnitedHealth Group is an innovative leader in the health and well-being industry, serving more than 55 million Americans. Through our family of companies, we contribute outstanding clinical insight with consumer-friendly services and advanced technology to help people achieve optimal health.

AmeriChoice is part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system.

If you're ready to help make health care work better for more people, you can make a historic impact on the future of health care at AmeriChoice.

We contract with states and other government agencies to provide care for over two million individuals. Working with physicians and other care providers, we ensure that our members obtain the care they need with a coordinated approach.

This enables us to break down barriers, which makes health care easier for our customers to manage. That takes a lot of time. It takes a lot of good ideas. Most of all - it takes an entire team of talent. Individuals with the tenacity and the dedication to make things work better for millions of people all over our country.

Position Description:
Positions in this function are responsible for providing expertise or general claims support to teams in reviewing, researching, investigating, negotiating, processing and adjusting claims. Authorizes the appropriate payment or refers claims to investigators for further review. Conducts data entry and re-work; analyzes and identifies trends and provides reports as necessary.

You can be a part of this team. You can put your skills and talents to work in an effort that is seriously shaping the way health care services are delivered.

Qualifications:

2 years of experience reading both UB and CMS forms is required

2 years of experience working with CPT and other claims coding tools is required

6 months claims processing experience is required

Proficient in using Microsoft programs including Excel and Word is required

FACETS experience is highly preferred

2 years of in-depth knowledge of United Healthcare claims processing systems (UNET, COSMOS, and EPD) and guidelines preferred

2 years of in-depth knowledge of Medicare reimbursement methodologies (i.e., Resource Based Relative Value System, DRG, Ambulatory Surgery Center Groupers, DRG) is preferred

2 year of in-depth understanding of claims processing guidelines including complex claims issues

Experience in a customer service call center is helpful

Experience working with both medical and behavioral health claims is beneficial

Integrity and Compliance:
- Can be relied upon to act ethically, to safeguard confidential information and to adhere to United Healthcare's Code of Conduct and all legal and regulatory requirements

Conscientiousness and Reliability:
- Maintains a high level of work quality, focuses on detail, and is dependable in meeting commitments and fulfilling obligations

Service Orientation:
- Ability and willingness to calmly and effectively assist customers and represent United Healthcare in a professional manner at all times

Initiative:
- Takes appropriate action in the pursuit of individual, group, and organizational objectives, before being asked to by others or forced by circumstances

Detail Oriented:
- Is systematic and thorough in completing work, focusing on details and completing work with minimal errors

Ability to interpret reimbursement methodologies and rates as outlined in the agreement with the provider

Ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action

Ability to independently plan, organizes, and prioritizes work

Ability to multi-task, shifting back and forth effectively between two or more activities or sources of information

Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.

HIDE