UnitedHealth Group Compliance Specialist (PeoplesHealth) - New Orleans, LA in METAIRIE-Louisiana, Louisiana
Coordinate and perform the compliance and policy activities within the Claims Department to accomplish company and department objectives and regulatory requirements established by the Centers for Medicare and Medicaid Services (CMS), and Louisiana Department of Insurance (DOI), and other regulatory organizations.
The Compliance Specialist is responsible for monitoring and auditing current processes to ensure the Claims Department meets all regulatory and business requirements. The incumbent works closely with the Director of Claims and other key claims management staff to identify compliance required process improvement, develop action plans, and ensure effective implementation of new processes. In addition to Claims Department staff, the Claims Compliance Coordinator will interact with interdepartmental and outside resources when integral to the successful outcome of audits and compliance projects.
Completes internal monitoring activities for the department, including compiling data, analyzing results, coordinating with department leadership to correct deficiencies and communicating with the Compliance Department
Serves as Compliance Department contact for the department. Coordinate compliance activities between the Claims Department and the Compliance Department, including, but not limited to education, training, communication, reporting activities, internal monitoring, auditing, and corrective actions
Communicates and coordinates with department leadership to ensure compliance with all standards within the department
Maintains working knowledge of all applicable CMS, DOI, and other regulatory organization regulations
Works with Director of Claims and other key claims management staff to communicate regulatory requirements
Assists the department in preparation for CMS and other oversight entity audits
Reviews and monitors non par denials to ensure accurate processing
Verifies and analyzes the accuracy of all tasks, data and information used or generated by OMT; resolves any discrepancies or problems and closes tasks timely
Requests reports utilized for timely claims payment reporting and updates Claims Management with current data, as well as documents comments as needed
Prepares and submits quarterly organization determination reports that meet CMS requirements
Organizes and facilitates meetings to implement regulatory requirements
Performs quarterly reviews for identified risk items
Researches and provides regulatory guidance and interpretation to staff inquiries
Completes Learnsource modules timely
Exhibits very good written communication skills by thoroughly and accurately documenting processes, policies and procedures, training manual material, status reports, etc.
Identifies areas for improvement regarding all regulatory and oversight requirements and coordinates with Director of Claims to develop and then implement an action plan for process improvement as needed
Operates as a team player and develops strong working relationships to ensure open communication and coordinates compliance efforts at all levels within Claims Department and interdepartmentally
Reports issues to the Director of Claims and assists with correcting those issues as needed
Performs other duties as assigned by claims management staff.
Bachelor’s Degree or equivalent work experience
Prior knowledge with legal, compliance, claims or audit experience
Intermediate or better proficiency with MS Word, MS Excel and MS Outlook
Previous research experience, gathering and analyzing data
Must live within a commutable distance of this specific career opportunity
Bachelor’s Degree with an emphasis in law
Strong claims processing or auditing knowledge and experience
Excellent verbal and written communication skills
Medical terminology and/or ICD-10 coding knowledge
Previous compliance experience
Familiarity with CMS (rules and regulations) language and interpretation
Every day, UnitedHealth Group helps to make the health care system work better for everyone. It's work on a scale like you've never seen before. Come help us strengthen the healthcare system as you do your life's best work.(sm)
Careers at UnitedHealthcare Medicare & Retirement.
The Boomer generation is the fastest growing market segment in health care. And we are the largest business in the nation dedicated to serving their unique health and well-being needs. Up for the challenge of a lifetime? Join a team of the best and the brightest to find bold new ways to proactively improve the health and quality of life of these 9 million customers. You'll find a wealth of dynamic opportunities to grow and develop as we work together to heal and strengthen our health care system. Ready? It's time to do your life's best work.(sm)
Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
Job Keywords: Metarie, LA, New Orleans, Compliance Analyst, Compliance Specialist, Claims, Auditing, Legal, CMS, coding, regulatory