Clinical Investigator - Eden Prairie, MN Job in Eden Prairie, MN 55346

Title: Clinical Investigator - Eden Prairie, MN
Location: MN-Eden Prairie
Ingenixis part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system.
If you get excited about the life transforming potential of bringing health care information to the right place, at the right time, to support crucial decisions, welcome to Ingenix.
We're one of the largest and fastest growing health information companies and the only organization in our industry with the information, technology and consulting expertise to solve the most significant challenges in health and human services.
As a vital member of the UnitedHealth Group family, we serve customers in every segment of the health care field. This includes government agencies, pharmaceutical companies, hospitals and health delivery networks, insurance providers and, of course, the diverse business divisions of UnitedHealth Group
Clinical Investigator - Eden Prairie, MN
Primary Responsibilities:
* An RN, LPN, or Certified Coder with strong medical knowledge
* Work with the Clinical Investigations Team
* Investigate, review, and research all types of post service claims with aberrant billing patterns, and may include claims related to post service utilization review
* Adhere to state and federal compliance policies, reimbursement policies, and contract compliance
* Serve as clinical resource and provide clinical expertise for clinical review of medical record and supporting documentation against submitted claim
* Document clinical findings within our investigation's case tracking system
* Investigative management - collaborate with entire investigative team and provide clinical guidance
* Identify treatment patterns and trends
* Analyze clinical investigation and provide written or verbal education to the provider
* Consult with Medical Director and other clinical resources when necessary
* Include complex decision making that maximizes investigation opportunities for our client
Bring your talent to an industry leader with the information, technology, and consulting expertise to help transform health and human services. No matter what your role, you'll be empowered to ask more questions, develop better solutions and help make the health care system greater than ever.
Qualifications:
* 1 years experience as an RN, LPN with a current, unrestricted license or Certified Coder is required
* 1 years of CPT/ICD-9 coding experience with a thorough knowledge of health insurance business, including knowledge of industry terminology, and regulatory guidelines is required
* Managed care experience is preferred, as is healthcare claims experience, and a background conducting clinical investigations
* High School Diploma or GED is required
* Secondary education is strongly preferred
Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.