Audit Team Lead, MA

2341190 This position is Remote in Massachusetts. You will have the flexibility to work remotely* as you take on some tough challenges.  Optum Insight is improving the flow of health data and information to create a more connected system. We remove friction and drive alignment between care providers and payers, and ultimately consumers. Our deep expertise in the industry and innovative technology empower us to help organizations reduce costs while improving risk management, quality and revenue growth. Ready to help us deliver results that improve lives? Join us to start Caring. Connecting. Growing together. The Audit Team Lead will be responsible for playing a leadership role in performing compliance reviews of medical and administrative documentation to identify instances of healthcare fraud and/or wasteful and abusive conduct by health care providers who submit claims for payment. This position will utilize information from claims data analysis, plan members, the medical community, law enforcement, employee conduct, and confidential investigations in order to document relevant findings.  The Audit Team Lead will lead site visits and desk audits of provider claims, and medical and administrative records, to gather and analyze all necessary information to determine whether subject adhered to state and federal compliance policies, reimbursement policies, and contract compliance.  The Audit Team Lead will present and discuss audit findings with client and input information into Optum audit workflow tools and the client’s case tracking system.  Where applicable, the Audit Team Lead will support appeal and fraud investigation activities.  Finally, the Audit Team Lead will supervise and support the work of other Auditors in all of the responsibilities noted here. This position is full time (40 hours/week) Monday – Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00 am – 5:00 pm EST. It may be necessary, given the business need, to work occasional overtime. We offer 8 weeks of paid training. The hours during training will be 8:00 am to 5:00 pm EST, Monday – Friday.   Primary Responsibilities: 

• Supervise and support the work of other Auditors as detailed below.
• Review medical and administrative records for audit/compliance review
• Travel to provider sites up to 25%/month to collect records and engage with providers
• Present and participate in discussions with client regarding audit observations and findings
• Collaborate with a team of 2-5 auditors to complete reviews
• Enter audit findings data and notes in online/electronic platform using Excel-based templates
• Attend and participate in dispute reviews and administrative hearings

  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: 

• High School Diploma or GED
• Must be 18 years of age OR older
• Nurse licensure (RN or LPN) or medical coder certification (CPC or CPMA)
• Must be willing to travel up to 25% within the state of Massachusetts
• 1+ years experience reviewing health care documentation in a clinical or administrative role
• 1+ years basic experience with Excel, including familiarity with basic formulas and data analysis
• Written and verbal communications skills
• Customer service skills
• Ability to work full time (40 hours/week), Monday – Friday, with flexibility for occasional overtime or weekend needs

  Preferred Qualifications:

• Clinical or administrative experience in long term care, for example, nursing facility care delivery/administration and/or community-based LTC service programs like Home Health
• Familiarity with Medicaid program and/or billing requirements
• Working knowledge of medical terminology and claim coding
• Experience in claim processing, healthcare provider information, and healthcare billing practices
• Familiarity with CPT-4, HCPCs and ICD-10 code terminology
• Experience working in a remote/telecommute workspace

  Telecommuting Requirements:

• Reside within Massachusetts
• Ability to keep all company sensitive documents secure (if applicable)
• Required to have a dedicated work area established that is separated from other living areas and provides information privacy.
• Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service

  *All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy   Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you’ll find a far-reaching choice of benefits and incentives. The salary for this role will range from  $72,800 – $130,000 annually based on full-time employment. We comply with all minimum wage laws as applicable.   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.