Clinical Appeals Reviewer Denials Team Jobs Vacancy in Unitedhealth Group Atlanta
Unitedhealth Group Atlanta urgently required following position for Clinical Appeals Reviewer Denials Team. Please read this job advertisement carefully before apply. There are some qualifications, experience and skills requirement that the employers require. Does your career history fit these requirements? Ensure you understand the role you are applying for and that it is suited to your skills and qualifications.
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Clinical Appeals Reviewer Denials Team Jobs Vacancy in Unitedhealth Group Atlanta Jobs Details:
Energize your career with one of Healthcare’s fastest growing companies.
Employees in this position are responsible for assembling and delivering written notification for Care Advocacy and Peer Reviewer issued denials within required timeframe for all levels of care for all delegated accounts. The denials may include Pre-Service and Concurrent UM and administrative requests, Post-Service cases (retrospective reviews, Clinical Claims Review) and reconsiderations.
- Retrieve work received from Care Advocacy via system work list
- Document request in A&G denial note
- Ensure accurate data entry
- Prioritize work based on due date and run applicable work list reports to monitor workload
- Plans, prioritize, organize and complete work to meet established and required time frames
- Ensure correct letter template is utilized
- Complete template with appropriate information and rationale
- Select correct attachment and / or enclosure(s) and add to template
- Send out completed written notification as indicated under applicable department policies
- Process mail / correspondence received for retrospective reviews
- Participates in workgroups and committees as requested
- Solves moderately complex problems independently
- Works with team to solve complex problems
- Supervision / guidance is required for higher level tasks
- Other duties as assigned
- High School Diploma / GED
- 1+ years of healthcare insurance experience
- Experience using a computer and Microsoft Office (Microsoft Word, Microsoft Excel, and Microsoft Outlook)
- 6+ months of data entry experience
- Must live in St. Louis, MO, Philadelphia, PA, San Francisco, CA, or Atlanta, GA
- Familiarity with medical terminology
- Experience with medical claims
- Any College experience
- Telephonic customer service experience
- Experience with ISET, IQ and / or UMR
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.