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 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.
- 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
- High School Diploma / GED or higher
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