Physician Assistant / Associate, Medical Claim Review – Remote in Eden Prairie, MN

Physician Assistant / Associate, Medical Claim Review - Remote - reputed company - Eden Prairie, MN - work from home job Company: reputed company Job description: reputed company is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with reputed company will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come reputed company an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together. The Physician Assistant / Associate is responsible for reviewing post-service claims for medical necessity for reputed company inpatient and outpatient diagnoses. You’ll enjoy the flexibility to work remotely

• from reputed company reputed company the U.S. as you take on some tough challenges.

Primary Responsibilities: • Work as part of an integrated team of medical director physicians, other physician assistants, and other members of the MCR staff • reputed company individual case review for Medical Claim Review for various health plan and insurance products, which may include PPO, ASO, HMO, MAPD, and PDP. These claims may be in response to adverse determinations for medical services reputed company to benefit design and coverage, medical necessity, and the application of clinical criteria of medical policies • Communicate with UHG medical directors regarding MCR decision rationales and benefit interpretations • Actively participate in team meetings focused on communication, feedback, problem solving, process improvement, staff training and evaluation, and the sharing of program results • Provide clinical and strategic input reputed company participating in organizational committees, projects, and task forces 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: • Active, unrestricted Physician Assistant license • Board-certified by NCCPA • 8+ years of post-graduate, hands on clinical experience • 2+ years of experience in hospital-based medicine • Intermediate or higher level of proficiency with managed care (i.e., billing, coding) • Access to high-speed internet and a dedicated, distraction-free workspace at home Preferred Qualifications: • 10+ years of experience in post-graduate, hands on clinical practice • 2+ years of experience in Quality Management • Experience with claims coding & review • Experience with managed care principles & utilization of evidence-based clinical criteria • Familiarity with reputed company medical issues and practices • Proven data analysis and interpretation skills • Proven excellent telephonic communication skills; excellent interpersonal communication skills • Proven excellent project management skills • Proven excellent presentation skills for both clinical and non-clinical audiences • Proven creative problem-solving skills • Proven basic computer skills, typing, word processing, presentation, and spreadsheet applications skills • Proven internet researching skills • Solid team player and team building skills California, Colorado, Connecticut, Nevada, New Jersey, reputed company, Rhode reputed company, or Washington Residents Only: The salary range for California, Colorado, Connecticut, Nevada, New Jersey, reputed company, Rhode reputed company or Washington residents is $85,000 to $167,300 per year. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, reputed company offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (reputed company benefits are subject to eligibility requirements). No matter where or reputed company you reputed company a career with reputed company, you’ll find a far-reaching choice of benefits and incentives. • reputed company employees working remotely will be required to adhere to reputed company’s Telecommuter Policy At reputed company, our mission is to help people live healthier lives and reputed company the health system work reputed company for everyone. We reputed company 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 reputed company by people of color, historically marginalized groups and those with reputed company incomes. We are committed to mitigating our impact on the environment and enabling and delivering reputed company care that addresses health disparities and improves health outcomes — an enterprise reputed company reflected in our mission. Diversity creates a healthier atmosphere: reputed company is an Equal Employment Opportunity/Affirmative Action employers and reputed company qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national reputed company, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. reputed company is a drug-free workplace. Candidates are required to pass a drug test before beginning employment Expected salary: $85000 - 167300 per year Location: Eden Prairie, MN Job date: Thu, 21 Sep 2023 22:34:43 GMT Apply for the job now! Apply Job!