UnitedHealth Group Claims Denial Management Lead - (AZ, CA, or NV) in Nevada

The Optum360 Service Area Denial Management Lead will provide denial management oversight and guidance to his/her designated service areas. This position is responsible for oversight of systemic trends through deep analytical analysis and facilitating process improvement that will minimize the fiscal impact of denials (including government audits). The Denial Management Lead will facilitate regular information sharing with Optum360 and client leadership. You will work with the client to review all proposed corrective actions plans and assure all action plans are implemented at the facility level.

Please note that this is a telecommuting position. However, you must live in CA, AZ, or NV to be considered.**

Primary Responsibilities:

  • Monitor key performance indicators and established denial trend metrics for designated service area(s)

  • Provide excellent customer service, resources and responsiveness to client’s needs as they relate to denial management activities; communicate concerns or issues on behalf of the client in relation to denial management performance, with the goal to expedite solutions and client satisfaction

  • Identify areas of deviance from system averages or expected best practice metrics

  • Analyze outcomes for trends and areas of opportunity; triangulate with other denial or government audit outcomes for both quantitative and qualitative executive summary reporting

  • Collaborate with other service area denial management leads to address service area specific issues, barriers to improvements, share information and collaborate toward solutions

  • Work with site stakeholders to facilitate their creation of a corrective action plan to address key issues

  • Monitor and report out progress of corrective action plans to clients and internal leadership

  • Monitor all vendor performance as it relates to Denial Management performance and Optum360 key initiatives

  • Facilitate effective goal oriented communication between client and Optum360 Denial Management Unit leadership; with the intent to provide meaningful information designed to effect operational changes toward efficiencies in care, improved revenue, and decreased denials and / or audits

  • Communicate project plans/ Action plans and trending to CFO/CEO client members monthly. Be able to answer questions in regards to denials and how Denials Management drive change month over month

Required Qualifications:

  • 3+ years’ experience in a revenue cycle operations role (Patient Access, CAC/Coding/HIM, Billing/Collections/Denials/Audit) with an understanding of issues which prompt denials

  • 5 years’ experience with government or non-government auditing and reimbursement methodologies as well as denial management

  • 2+ years of experience with documenting processes and practices

  • Must possess intermediate level proficiency with Microsoft Office programs to build reports, presentations and spreadsheets (Excel, PowerPoint, Word)

Soft Skills Required:

  • Excellent Customer Service Skills

  • Demonstrated ability to lead a multidisciplinary team; ability to form a workgroup and lead them through an action plan which results in denial reduction

  • Demonstrated leadership skills, professionalism, organization, growth and development of staff

  • Demonstrated experience driving change and holding accountable clinical and non-clinical facility personnel

  • Advanced Critical Thinking Skills. Ability to analyze data and draft summary presentations demonstrating outcomes

  • Executive level presence in both presentation and persuasion skills. Must be able to negotiate with leaders regarding prioritization of work.

  • Experience working autonomously, must be self-starter.

  • Detail oriented and ability to effectively handle multiple priorities and deadlines

  • Excellent verbal / written communication and interpersonal skills

  • Ability to collaborate with others

Careers with Optum360. At Optum360, we're on the forefront of health care innovation. With health care costs and compliance pressures increasing every day, our employees are committed to making the financial side more efficient, transferable and sustainable for everyone. We're part of the Optum and UnitedHealth Group family of companies, making us part of a global effort to improve lives through better health care. In other words, it's a great time to be part of the Optum360 team. Take a closer look now and discover why a career here could be the start to doing your life's best work.(sm)

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

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.

Job Keywords: Revenue Cycle, Denial, Billing, Patient Financial Services, audit, hospital operations, clinical operations