Sr Payment Integrity Analyst – Fraud Waste and Abuse – Optum Serve – Remote in Chicago, IL

Sr Payment Integrity Analyst - Fraud Waste and Abuse - Optum Serve - Remote - UnitedHealth Group - Chicago, IL - work from home job

Company: UnitedHealth Group

Job description: 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 Serve helps federal agencies and communities across the nation tackle some of the biggest challenges in health care. With trillions of dollars spent on health care annually, in the United States, the potential for abuse is staggering. Even worse, the lives of millions of patients hang in the balance.

Join Optum Serve as a Senior Payment Integrity (PI) Analyst where you will be responsible for identification, investigation and prevention of healthcare Fraud, Waste, and Abuse (FWA) The Sr. PI Analyst will utilize claims data, applicable policy and guidelines, and other sources of information to identify aberrant billing practices and patterns. The Sr. PI Analyst is responsible for conducting investigations which will require the gathering of all relevant facts, records and/or other relevant documentation.

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

Primary Responsibilities: • Investigate highly complex cases of Fraud, Waste, and Abuse (FWA) • Detect fraudulent activity by beneficiaries, providers, and other parties against the government contracts • Develop and deploy the most effective and efficient investigative strategy for each investigation • Maintain accurate, current, and thorough case information in the case tracking system • Collect and secure documentation or evidence and prepare summaries of the findings • Collect, collate, analyze, and interpret data relating to fraud, waste, and abuse referrals • Document and report financial impact of investigation outcomes • Ensure compliance of applicable federal/state regulations or contractual obligations • Collaborate with internal business partners to help drive the investigation process • Collaborate with a variety of external sources to identify current and emerging patterns and schemes related to fraud, waste, and abuse (e.g., NHCAA, law enforcement) • Participate in and complete required deliverables, as part of the federal contract • Participate in any audits requested by the government • Comply with goals, policies, procedures, and strategic plans as delegated by leadership • Collaborate with federal partners, to include attendance at workgroups, regulatory meetings, requests for information, subpoenas, or case discussions • Communicate effectively, to include written and verbal forms of communication • Manage and prioritize assigned caseloads to meet required turnaround times • Serves as a key resource on complex and/or critical issues

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: • 5+ years of experience in health care Fraud, Waste, and Abuse (FWA) • 5+ years of experience conducting or managing comprehensive research to identify billing abnormalities, questionable billing practices, irregularities, and fraudulent or abusive billing activity • Experience with federal FWA programs and contracts • Demonstrated knowledge of applicable medical terminology and coding guidelines (e.g., CPT, HCPCS, ICD-9, ICD-10) • Demonstrated understanding of how claims are processed and adjudicated • Demonstrated understanding and navigation of claims processing platforms

Preferred Qualifications: • Accredited Health Care Fraud Investigator (AHFI) • Certified Fraud Examiner (CFE) • 5+ years of experience developing investigative strategies • Advanced knowledge and experience of Statistical Analysis • Proficiency in performing financial and statistical analysis including statistical calculation and interpretation

California, Colorado, Connecticut, Nevada, New Jersey, New York, Rhode Island, or Washington Residents Only: The salary range for California, Colorado, Connecticut, Nevada, New Jersey, New York, Rhode Island or Washington residents is $85,000 to $167,300. 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.
• All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

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.

Expected salary: $85000 - 167300 per year

Location: Chicago, IL

Job date: Sat, 26 Aug 2023 22:23:12 GMT

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