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Enrollment Quality Analyst - Las Vegas, NV

Company: UnitedHealth Group
Location: Boulder City
Posted on: March 17, 2023

Job Description:

If you are located in Las Vegas, NV, you will have the flexibility to work from home and the office in this hybrid role as you take on some tough challenges.

Working in Operations at UnitedHealth Group is one of the toughest and most fulfilling ways to help people, including yourself. We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement. Join us and start doing your your life's best work. SM

The Enrollment Quality Analyst conducts the necessary research and coordination to ensure all Enrollments, Disenrollment's, Plan Changes and Reconciliation activities are accurately processed. You will conduct audits and provide feedback to reduce errors, improve processes, performance and ensure quality and consistency. There will be interaction via telephone and written correspondence with the Compliance team(s) to ensure the Enrollment Department meets and exceeds all regulatory standards. Additionally, this position will work closely with Compliance regarding coordination to HIPAA, Model Audit Rule (MAR), Healthcare Effectiveness Data and Information Set (HEDIS), and any other CMS or compliance related activities.

This position is full-time (40 hours/week) Monday to Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 07:00am - 05:00pm PST. Our office is located at 2720 N TENAYA WAY, LAS VEGAS, 89128. Employees will be required to work some days onsite and some days from home.

All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.

Primary Responsibilities:

  • Interact with Compliance team members via telephone, conference meetings, or e-mail to explain and verify the Enrollment Department's member enrollment data entered into the EAM and Facets databases meet the CMS standards, from the point of member application receipt to the mailing of new member material
  • Assist with internal and external audits of the Enrollment Department to ensure procedural standards are consistently adhered to by the Enrollment staff. Provide feedback to reduce errors, improve processes and performances, and ensure the quality and consistency
  • Conduct necessary research and coordination as necessary for all audit / compliance related activities.
  • Responsible for identifying recommended training/retraining of Enrollment processes or techniques to meet accuracy requirements
  • Ensure all audit reports support the overall score of the Enrollment Department and compliance strategies
  • Investigate, record, resolve, maintain and report all member complaints and grievances
  • Support the process of validating workflows and communication tools to best enhance Quality Assurance (QA)
  • Identify, investigate, and report non-conformances to management
    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 / GED (or higher)
    • 2+ years of claims or collections experience
    • 1+ years of experience in healthcare industry
    • Knowledge of CMS Guidelines
    • Experience with computer and Windows PC applications including Microsoft Excel (entering and interpreting data), Microsoft Word (create, edit, read) and Microsoft Outlook (read, create and send emails)
      Telecommuting Requirements:
      • Reside within Las Vegas, NV
      • Required to have a dedicated work area established that is separated from other living areas and provides information privacy
      • Ability to keep all company sensitive documents secure (if applicable)
      • Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service
        Preferred Qualifications:
        • 1+ years of experience with FACETS
        • Prior Quality Auditing experience
        • HIPAA compliance experience
          Careers at UnitedHealthcare Employer & Individual. We all want to make a difference with the work we do. Sometimes we're presented with an opportunity to make a difference on a scale we couldn't imagine. Here, you get that opportunity every day. As a member of one of our elite teams, you'll provide the ideas and solutions that help nearly 25 million customers live healthier lives. You'll help write the next chapter in the history of healthcare. And you'll find a wealth of open doors and career paths that will take you as far as you want to go. Go further. This is your life's best work. SM

          Nevada Residents Only: The salary range for Nevada residents is $22.45 to $43.89. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you'll find a far-reaching choice of benefits and incentives.

          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.

          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.

Keywords: UnitedHealth Group, Las Vegas , Enrollment Quality Analyst - Las Vegas, NV, Professions , Boulder City, Nevada

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