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Recovery / Resolution Consultant - Sacramento, CA - US Telecommute

  • Jobs With Remote
  • California, USA
  • May 14, 2019

Job Description

Energize your career with one of Healthcare?s fastest growing companies.??

You dream of a great career with a great company ? where you can make an impact and help people.? We dream of giving you the opportunity to do just this.? And with the incredible growth of our business, it?s a dream that definitely can come true. Already one of the world?s leading Healthcare companies, UnitedHealth Group is restlessly pursuing new ways to operate our service centers, improve our service levels and help people lead healthier lives.? We live for the opportunity to make a difference and right now, we are living it up.

This opportunity is with one of our most exciting business areas: Optum ? a growing part of our family of companies that make UnitedHealth Group a Fortune 5 leader.

Optum helps nearly 60 million Americans live their lives to the fullest by educating them about their symptoms, conditions and treatments; helping them to navigate the system, finance their healthcare needs and stay on track with their health goals. No other business touches so many lives in such a positive way. And we do it all with every action focused on our shared values of Integrity, Compassion, Relationships, Innovation & Performance.

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

The Recovery and Resolution Consultant - Sacramento, CA ? ?US Telecommute is responsible for identifying internal and payer issues by analyzing AR greater than 90 days andconducting regular Joint Operating Committee Meetings (JOCs) to address payer issues. Will work with payer and internal Revenue Cycle teams to provide problem resolution. Communicates well, to explain research and findings to management and may be utilized as a training resource within the department or to external customers. ?Must have experience reading hospital contracts, account review experience, and analytical work experience to provide trends and claims issues.? This position requires the ability to work well independently and also succeed in a team environment to hit deadlines as needed. The Recovery and Resolution Consultant also assists in the improvement of internal business processes and meeting future reimbursement service needs.

Primary Responsibilities:
  • Analyze claims data to identify trends / claims issues and provide reports to Management as necessary
  • Breakdown complex problems into individual root causes
  • Ensure that reimbursement procedures adhere to insurance regulations and payers? contractual obligations
  • Review claim payment accuracy, timeliness, and collection processes by ensuring issues are avoided, or if identified, resolved timely and appropriately
  • Conduct regular JOC (Joint Operating Committee) meetings with assigned payers to address and resolve identified payer issues in a timely manner
  • Prepare and coordinate presentations, trainings, etc; used as an educational resource
  • Create and maintain relationships with internal departments / payers to work to resolve reimbursement issues and make recommendations for improving processes
  • Serve as a Subject Matter Expert (SME) for Internal Departments, Vendors, Management and Clients on payer processes and policies
  • May involve some interfacing with clients, managed care customers, Payer resources, and others when needed
  • Manage progress of payer projects within Aha Project Management database
  • Lead various special projects as needed with little to no manager supervision or assistance
Required Qualifications:
  • High School Diploma / GED (or higher)
  • 5+ years collections (in patient acute hospital) experience
  • 3+ years of analytics experience (able to review accounts to isolate trends, pull data and communicate trends effectively to senior level reporting)
  • 5+ years? experience in reading Hospital based contacts
  • Proficient with Microsoft Word (creating and editing documents), Microsoft Excel (pivot tables), and Microsoft Powerpoint (creating and editing slides)
  • Knowledge of state, federal and industry standard fee schedules, reimbursement methodologies and regulations, including but not limited to: DRG, ASC, APR-DRG, and OPPS
  • Ability to travel?5% or less of the time
Preferred Qualifications:
  • Associate?s Degree (or higher)
  • 6+ years as a senior collector
  • 4+ years analytic experience
  • 2+ years? experience running a Joint Operating Committee meeting
  • Ability to perform basic mathematical calculations, balance and reconcile figures
Soft Skills:
  • Strong written and oral communication skills
  • Strong analytical, problem solving and organizational skills
  • Must be able to work well independently and also succeed in a team environment
  • Demonstrated ability to handle multiple projects simultaneously and prioritize projects
  • Demonstrated ability to meet deadlines, multi - task, problem solve, use appropriate technology to analyze business problems and deliver accurate and precise results
  • Demonstrated ability to analyze complex claims transactions
Healthcare isn?t just changing. It?s growing more complex every day. ICD - 10 Coding replaces ICD - 9. Affordable Care adds new challenges and financial constraints. Where does it all lead? Hospitals and Healthcare organizations continue to adapt, and we are vital part of their evolution. And that?s what fueled these exciting new opportunities.

Who are we? Optum360. We?re a dynamic new partnership formed by Quest and Optum to combine our unique expertise. As part of the growing family of UnitedHealth Group, we?ll leverage our compassion, our talent, our resources and experience to bring financial clarity and a full suite of Revenue Management services to Healthcare Providers, nationwide.

If you?re looking for a better place to use your passion, your ideas and your desire to drive change, this is the place to be. It?s an opportunity to do your life?s best work.

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: Senior Collector, Inpatient, Acute Hospital, Joint Operations Committee, JOC, Collections, Analytics, Hospital Contracts, Sacramento, CA