Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.
Primary Responsibilities:
- The implementation and day-to-day performance of process activities related to Accounts Receivable process. These processes include the review of claims, contracts and fee schedules to identify and resolve incorrectly paid/denied/rejected claims and processing, procedural, systemic and billing errors and practices leading to claims denials
- The incumbent will actively analyze potential for provider and vendors as well as various internal divisions to ensure that potential recovery opportunities are appropriately identified by fixing the denied/rejected claims
- Perform complex claims analysis and audit activities to identify trends, determine root cause of payment inaccuracies, and to recommend / implement process and systems improvements
- Ensure that team performance metrics are achieved and maintain an effective Team environment
- Build and maintain effective relationships with internal customers (i. e. US Onshore Partners / Supervisors, Managers and Directors etc.)
- Monitoring the SLAs, KPIs for the process, identifying improvement areas and implementing adequate measures to maximize customer satisfaction level
- Coordinate with the Team to identify process improvement opportunities
- Maintain production and quality databases and spreadsheets for analysis and day to day reporting
- Partner with leadership to promote department revenue and business objectives
- Provide feedback to management on individual and team performance
- Identify root cause of errors and opportunities for claims denial reduction
- Analyze and develop overall improvement plans (department and individual)
- Measuring and tracking team performance
- Provide feedback to team members on a regular basis
- Review and update process SOP's/documents as needed
- Create innovative solutions to an extensive range of complex data requests
- Comply with the terms and conditions of the employment contract, company policies and procedures, and any and all directives (such as, but not limited to, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regards to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment). The Company may adopt, vary or rescind these policies and directives in its absolute discretion and without any limitation (implied or otherwise) on its ability to do so
Required Qualifications:
- Bachelor's degree or equivalent experience (any stream)
- 5+ years in US healthcare and/or AR claim experience
- 2+ years of experience in Team Handling (18 - 20 people)
- Sound knowledge of RCM (AR, PP & CB)
- Extensive knowledge of NextGen, Allscripts, Epic as well as desktop applications
- Solid knowledge of US Health care and should have knowledge of AR, CE, CB and PP LOB
- Fair understanding of UB04 & HICFA 1500 claim forms
- Exposure to all the facets of Operations Management
- Exposure to People Management, Performance Management and Client Management
- Proficient in MS Office software; particularly Excel and Outlook and PPT's
- Proven excellent analytical skills
- Proven excellent written and verbal communication skills
- Demonstrated solid work ethic and a high level of professionalism with a commitment to client/Management satisfaction and have functional knowledge of HIPAA rules and regulations
- Demonstrated ability to communicate effectively both verbally and in writing
- Demonstrated ability to analyze data to identify trends and issues
- Demonstrated ability to make decisions and work independently
- Willing or open to Night Shifts
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.