Description
Ingenix 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 get excited about the life transforming potential of bringing health care information to the right place, at the right time, to support crucial decisions, welcome to Ingenix.

We're one of the largest and fastest growing health information companies and the only organization in our industry with the information, technology and consulting expertise to solve the most significant challenges in health and human services.

As a vital member of the UnitedHealth Group family, we serve customers in every segment of the health care field. This includes government agencies, pharmaceutical companies, hospitals and health delivery networks, insurance providers and, of course, the diverse business divisions of UnitedHealth Group.

Senior Nurse Recovery/Resolution Analyst - Portland, ME

Primary Responsibilities:
Chiefly responsible for reviewing provider dispute medical documentation for accuracy of original claim submission and provider's billing practices
Extensive research on insurance policies, provider billing manuals and provider contracts
Summarizes and documents specifics of the review
Reviews and resolves provider disputes in a timely manner consistent with the goals of Ingenix and its clients
Manages own PR case work load, ensuring expedient resolution for all provider disputes
Communicates directly with providers regarding disputes
Creates weekly analysis of case log, working with PR Manager to ensure appropriate rate of closure
Attends onsite reviews
Attends and/or participates in hearings
Participates in letter QA and generation process
Works with other PR personnel on a daily basis and provides assistance with all areas of PR tasks when needed
Works as an integral part of the Client, Algorithm, and Letter Factory Teams
Participates in early stage client/project planning
Works collaboratively with PR Manager, Client Manager and Algorithm Team to communicate disputes, trends, concerns, ideas
Participates in all staff meetings
Participates in all algorithm/letter training sessions
Participates in innovation processes to develop new tools and strategies to enhance PR performance
Actively identifies and shares best practices
Develops tools for active knowledge sharing and management
Bring your talent to an industry leader with the information, technology, and consulting expertise to help transform health and human services. No matter what your role, you'll be empowered to ask more questions, develop better solutions and help make the health care system greater than ever.
Qualifications
Qualifications:
RN degree required and current license
Extensive experience as a nurse medical reviewer
3 - 5 years experience reviewing providers medical and pharmacy dispute documentation for accuracy of original claim submission and provider's billing practices
2 - 5 years medical claims coding & processing experience (ICD 9 , CPT, HCPCS, revenue codes, DRG, POS, NDC)
2 - 5 years experience working with Medicaid, Medicare and Commercial Insurance entities as well as with paid claims data
2 - 5 years clinical background required
Excellent research skills including but not limited to insurance policies and regulations (State and/or Federal specific, provider billing manuals, provider contracts & different websites)
Excellent oral and written communication skills as well as experience with provider negotiation/settlement agreements for overpayments
Outlook, MS Word, Excel, Internet research required as well as having a good comfort with learning different internal systems/applications
Extremely organized, detail oriented, flexible, positive and multitasking skills are required
Ability to work individually as well as collaboratively on multidisciplinary teams
Ability to occasionally lift 25 lb.
Certified Medical Coder a plus but not required
Previous healthcare call center experience is preferred but not required
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.