Facility Reimbursement Policy Clinical Consultant

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.



Ingenix, a UnitedHealth Group company, is one of the largest health care information and research companies in the industry. No one competitor offers the same breadth of products and services as Ingenix. In fact, our competitors strive to copy what we have done. We offer the most comprehensive set of data, technology and analytic capabilities. The power of our products and services help customers leverage information assets, enhance clinical and financial insight, increase the quality of health care delivery and administration and improve cost management. 


 


We need a knowledgeable, experienced professional to serve as the in-house industry expert on coding, billing and reimbursement policy for facility inpatient and outpatient content. This individual will also research and design written Edit Rationale Statements that support reimbursement policy standards. These Edit Rationale Statements will contribute to new software that edits UB-92 content. This is an exciting opportunity for an individual with the right skills to have an impact on a system that will benefit many Ingenix clients and the software development team by creating great value and efficiency. If you've ever wished you had a tool that would make it easier to edit facility bills, whether that editing is done as part of the hospital billing or the claims adjudication process, we encourage you to apply!

Primary responsibilities include:


Serving as the in-house industry expert on facility coding, billing, and reimbursement policy

Researching websites, industry sources and working with user groups to source information for the KnowledgeBase

Developing written Edit Rationale Statements to support editing software for facility claims

Collaborating with the product management team to create a new claims editing software tool that will facilitate correct coding, billing, and claims adjudication processes

Contributing to a robust pipeline of new product ideas 



Applicants must demonstrate a working knowledge of hospital revenue cycle management as well as an understanding of claims adjudication processes in health plans.  This knowledge must include both inpatient and outpatient experience.  Candidates with a formal coding certification are strongly preferred. Demonstrated experience in auditing hospital claims from a coding perspective would be valuable.


 


UnitedHealth Group offers a full range of comprehensive benefits, including medical, dental and vision, as well as a matching 401k and an employee stock purchase plan.


 


If you are interested in growing professionally within an innovative, highly respected organization, we invite you to explore this excellent growth opportunity!


 


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