Claims Review Medical Director FCR - Endovascular Surgery - Telecommute

White Plains, NY

full-time
Outpatient

Primary Responsibilities:

  • Reviews surgical and other professional claims for correct coding using clinical record
  • Participation in Training regarding URAC, NCQA, Regulatory Compliance, Confidentiality, Conflict of Interest, HIPAA, and department specific training as applicable
  • Discusses cases and clinical coding situations with treating providers telephonically during scheduled hours
  • Participates in periodic clinical conferences / calls and in ongoing internal performance consistency reviews
  • Composes, if needed, patient situation specific, clinical summaries and rationales for medical necessity decisions
  • Be available for occasional, periodic weekend and holiday as needed telephonic and remote computer expedited clinical decisions
  • Supports compliance with regulatory agency standards and requirements (e.g., CMS, NCQA, URAC, state / federal and third-party payers)
  • Be able to travel to scheduled company meetings and activities in US
  • Be able to assist in marketing presentations to clients and ongoing relationship management activities with existing clients if requested to do so
  • Provide Clinical support for staff ...For complete description tap [HERE][1]

Colorado Residents Only: The salary range for Colorado residents is $254,600 to $295,200. The range and pay mix of base and bonus is variable based upon experience and metric achievement. 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.

[1]: https://careers.unitedhealthgroup.com/job/13179064/claims-review-medical-director-fcr-endovascular-surgery-telecommute-remote/


Posted June 24, 2021