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We have modest goals: Improve the lives of others. Change the landscape of health care forever. Leave the world a better place than we found it. Such aspirations tend to attract a certain type of person. Crazy talented. Compassionate. Driven. To these individuals, we offer the global reach, resources and can-do culture of a Fortune 5 company. We provide an environment where you’re empowered to be your best. We encourage you to take risks and in return, offer a world of rewards and benefits for performance. Exceeding your limits is an exceptional start to your life's best work.SM

 

Just like you, we are driven by a set of fundamental principles that are guiding our way forward. Our values of integrity, compassion, relationships, innovation, and performance serve as a foundation to transform health care. Are you in? Learn more about your future at UnitedHealth Group at careers.unitedhealthgroup.com

 

Job Category:

Claims

Country:

US

Approximate Salary:

Not Specified

Position Type:

Full Time

Recovery and Resolution Consultant - Sacramento, CA Telecommute

UHG - Sacramento, California

Posted: 11/12/2018

Welcome to 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 life's best work.

If you are located in Sacramento, you will have the flexibility to telecommute* as you take on some tough challenges. We’ll put you in the driver's seat on vital projects that have strategic importance to our mission of helping people lead healthier lives. Yes, we share a mission that inspires. We need your organizational talents and business discipline to help fuel ours. It's the opportunity to do your life's best work. (sm)

 

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

 

The Recovery and Resolution Consultant is responsible for identifying internal and payer issues by analyzing AR greater than 90 days and conducting 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), Excel (pivot tables), and 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 of analytics experience (able to review accounts to isolate trends, pull data and communicate trends effectively to senior level reporting)
  • 2+ years experience running a Joint Operating Committee meeting
  • Ability to perform basic mathematical calculations, balance and reconcile figures
  • Demonstrated ability to analyze complex claims transactions

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

Careers with OptumInsight. Information and technology have amazing power to transform the Healthcare industry and improve people's lives. This is where it's happening. This is where you'll help solve the problems that have never been solved. We're freeing information so it can be used safely and securely wherever it's needed. We're creating the very best ideas that can most easily be put into action to help our clients improve the quality of care and lower costs for millions. This is where the best and the brightest work together to make positive change a reality. This is the place to do your life’s best work.SM

 

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

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