• Conduzir entrevistas e coletas de informações junto às áreas de negócio para levantar atividades de tratamento, finalidades, bases legais, fluxos de dados, retenção e compartilhamentos. • Estruturar e manter o registro de atividades de tratamento (RoPA) na ferramenta do cliente (o treinamento será fornecido pelo parceiro). • Organizar e validar o inventário de dados, mapeando fluxos e classificando dados pessoais e sensíveis. • Garantir a consistência e a qualidade dos registros antes da apresentação ao cliente. • Documentar pendências, formalizar o status por e-mail com os envolvidos corretos e manter o time atualizado no quadro de gestão. • Cumprir o SLA de mapeamento acordado.

• Assegurar a condução eficiente dos projetos em saúde corporativa dos clientes HBit; • Definir e monitorar rigorosamente o desempenho e status de cada projeto; • Analisar as diretrizes e objetivos do projeto; • Desenvolver e fomentar indicadores, dashboards e relatórios de progresso; • Assegurar a comunicação e integração eficiente entre os times operacionais e de suporte; • Identificar gargalos dos projetos para otimizar o staff; • Remover impedimentos que dificultam o progresso do projeto; • Promover melhoria contínua dos projetos.

Role Description The Itemized Bill Review (IBR) Clinical Appeals Reviewer will analyze and respond to client and/or hospital claim review appeal inquiries. Handles medical record review, analyzes data, and completes the response resolution for clients and the business unit. Must utilize expertise in auditing to review and provide response to appeals. We are seeking self-motivated, solution-oriented and skilled problem solvers who provide clinical reviews with written documentation under tight deadlines. This position is full-time, Monday - Friday. Employees are required to work our normal business hours of 8:00am - 5:00pm. It may be necessary, given the business need, to work occasional overtime or weekends. You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities: - Analyze scope and resolution of IBR Appeals - Respond to Level one, two or higher appeals - Perform complex conceptual analyses - Identify risk factors, comorbidities, and adverse events to determine if overpayment or claim adjustment is needed - Review governmental regulations and payer protocols and/or medical policy to recommend appropriate actions - Research and prepare written appeals - Exercise clinical and/or coding judgment and experience - Collaborate with existing analysts, quality and leadership team to seek to understand and review medical records pertaining to impacted claims - Navigate through web-based portals and independently utilize other online tools and resources including but not limited to Word, Adobe, Excel - Serve as a key resource on complex and/or critical issues and help develop innovative solutions - Define and document/communicate business requirements Qualifications - Undergraduate nursing degree - Unrestricted RN (registered nurse) license - 2+ years of appeals experience (coding or auditing) - Experience with CPT-4 coding, NCCI edit resolution and appropriate modifier use - Advanced experience with regulations, compliance and composing professional appeal responses - Advanced experience with ICD10 CM coding and ICD 10 PCS coding - Willing or ability to work our normal business hours of 8:00am - 5:00pm - Proven ability to keep all company sensitive documents secure (if applicable) - Have a dedicated work area established that is separated from other living areas and provides information privacy - 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 - Clinical claim review experience - Managed care experience - Investigation and/or auditing experience - Advanced experience using Microsoft Excel with the ability to create/edit spreadsheets, use sort/filter function, and perform data entry - Knowledge of health insurance business, industry terminology, and regulatory guidelines Requirements - *All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy Benefits - Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. - In addition to your salary, we offer benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). - The hourly pay for this role will range from $35 - $63 per hour based on full-time employment. - We comply with all minimum wage laws as applicable. Application Deadline This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

• Implementing, maintaining, and optimizing Workday Human Capital Management (HCM) functionalities. • Working closely with HRIS Product Owners and responsible for Workday configuration, analytics, reports, integrations, and security. • Collaborating with HRIS organization, External Application Managed Services, IT, HR, Payroll, and Finance to understand business processes and compliance requirements, evaluate system impacts, and deliver scalable Workday solutions that align with business objectives and support long-term system sustainability. • Resolving enhancement requests from monthly release and enhancement cycles across Workday HCM modules, partnering with HRIS Product Owners and business stakeholders to design, document, test, and deploy scalable solutions. • Participating actively in Workday HCM enhancement initiatives, system upgrades, and support projects, serving as a functional and technical subject matter expert. • Configuring and maintaining Workday functionality including business processes, reports, integrations, calculated fields, and analytics while ensuring solutions are designed for long-term scalability and maintainability. • Reviewing business requirements with stakeholders, recommending appropriate system solutions, and configuring and deploying enhancements aligned with business objectives and Workday best practices. • Maintaining detailed system documentation in accordance with SOX and SDLC requirements established by Alignment Healthcare. • Managing and resolving HRIS support cases within established service level agreements (SLAs), ensuring timely resolution and clear communication with stakeholders. • Developing and maintaining user guides, job aids, and process documentation with a focus on improving the employee and manager user experience. • Supporting internal and external audits by providing system documentation, data validation, and evidence of controls and compliance processes.