Appeals Physician Associate

At UnitedHealth Group, we are dedicated to improving the health and well-being of individuals and communities across the nation. As an Appeals Physician Associate, you will play a crucial role in our mission by utilizing your medical expertise and knowledge of insurance and reimbursement processes to ensure fair and accurate claim decisions for our members. We are seeking a highly skilled and compassionate individual who is committed to upholding our values of integrity, compassion, relationships, innovation, and performance. Join us in making a positive impact on the healthcare industry and the lives of those we serve.

1. Review and process appeals from members and providers regarding claim decisions, ensuring timely and accurate resolution.
2. Utilize medical knowledge and expertise to evaluate the medical necessity of procedures and treatments, and determine appropriate coverage and reimbursement.
3. Collaborate with internal teams, including claims and clinical staff, to gather and analyze relevant information and make informed decisions.
4. Maintain a thorough understanding of UnitedHealth Group policies, procedures, and contractual agreements to ensure compliance and consistency in appeal decisions.
5. Conduct research and stay updated on industry trends and changes in healthcare regulations and reimbursement guidelines.
6. Communicate with members and providers in a professional and empathetic manner, providing clear explanations of appeal decisions and addressing any concerns or questions.
7. Maintain accurate and detailed records of appeal decisions and related documentation.
8. Participate in team meetings and trainings to share knowledge and best practices, and contribute to process improvement initiatives.
9. Adhere to all ethical and legal standards, and uphold UnitedHealth Group's values of integrity, compassion, relationships, innovation, and performance.
10. Continuously seek opportunities to improve the appeal process and overall member experience, and provide feedback to leadership for potential enhancements.

According to JobzMall, the average salary range for a Appeals Physician Associate in Eden Prairie, MN, USA is $86,000 - $131,000 per year. This range can vary depending on factors such as experience, education, and the specific organization or healthcare facility the individual is employed by.

UnitedHealth Group Incorporated is an American for-profit managed health care company based in Minnetonka, Minnesota. UnitedHealth Group, Inc. provides health care coverage, software and data consultancy services. It operates through the following segments: UnitedHealthcare, OptumHealth, OptumInsight, and OptumRx. The UnitedHealthcare segment utilizes Optum's capabilities to help coordinate patient care, improve affordability of medical care, analyze cost trends, manage pharmacy benefits, work with care providers more effectively, and create a simpler consumer experience.