Denial Management Prevention Lead – Sacramento, CA or Telecommute

UnitedHealth Group
Published
May 24, 2021
Location
Atlanta, GA
Category
Job Type

Description

You believe data can help reshape the future, and you find yourself loving the thrill of diving into challenging analysis. At UnitedHealth Group, you'll find an organization that will recognize those talents and have lots of growth potential. Here, you will be empowered, supported and encouraged to use your analysis expertise to help change the future of health care. Does the challenge intrigue you?

Optum360 is a dynamic new partnership formed by Dignity Health and Optum to combine our unique expertise. As part of the growing family of UnitedHealth Group, we'll leverage all our resources to bring financial clarity and a full suite of revenue management services to health care providers nationwide.

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

The Optum360 Denial Management/Prevention Lead will provide denial management and prevention oversight and guidance to any service area needed. 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/Prevention 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.

You’ll enjoy the flexibility to telecommute* from anywhere within United States as you take on some tough challenges.

Primary Responsibilities:

  • Prepare and present highly professional monthly Denial Management presentations for client CFOs
  • Act as project leader for Denial Management global initiatives as assigned by leadership
  • Collaborate with operational leaders to develop solutions (using DMAIC methodologies)
  • 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
  • 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 team members 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
  • Facilitate operational owners' review of action items during monthly Denial Meetings with client CFOs
  • Facilitate effective goal-oriented communication between client and Optum360 Denial Management Unit leadership; with the intent to provide meaningful information designed to affect operational changes toward efficiencies in care, improved revenue, and decreased denials and/or audits.
  • Additional duties as assigned

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

  • Bachelor’s degree (Major in Business, Finance, Health Administration, or related field a plus) or equivalent work experience
  • 5+ years of experience working with hospitals and operations or clinical professionals
  • 3+ years of experience in Healthcare Revenue Cycle including Denials Management and Payor Appeals
  • 3+ years of experience working with Patient Financial Services, Business Office, Insurance claim billing, Collections, Reimbursement, Patient Access, Coding
  • 2+ years of experience with government or non-government auditing and reimbursement methodologies
  • 2+ years of experience analyzing large data sets to identify trends, develop baselines, and track improvement in order to create summary presentations demonstrating outcomes
  • 2+ years of experience presenting to executive level audiences
  • 2+ years of Project Management experience
  • 2+ years of experience with documenting processes and practices
  • Advanced with Excel, PowerPoint, Word, Outlook with ability to build reports, presentations, spreadsheets, and process maps
  • Ability to telecommute, work independently, and travel to west coast as needed (25-50%)
  • If you need to enter a work site for any reason, you will be required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or similar UnitedHealth Group-approved symptom screener. When in a UnitedHealth Group building, employees are required to wear a mask in common areas. In addition, employees must comply with any state and local masking orders

Preferred Qualifications:

  • Six Sigma or Lean Sigma certification, training, or experience
  • Some experience with Microsoft Visio, SharePoint
  • Demonstrated leadership skills, professionalism, organization, growth and development of staff
  • Strong organizational skills

As a Fortune 7 company with 260,000 people all pulling in the same direction, we’re used to setting the pace for change. Challenge yourself, your peers and our industry by shaping what health care looks like. It is sure to be your life’s best work.(sm)

Optum360 is a dynamic new partnership formed by Dignity Health and Optum to combine our unique expertise. As part of the growing family of UnitedHealth Group, we'll leverage all our resources to bring financial clarity and a full suite of revenue management services to health care providers nationwide.

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

Colorado Residents Only: The salary range for Colorado residents is $79,700 to $142,600. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

*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: Denial Management, Prevention Lead, Analyze, Process, Project, Excel, Visio, Leader, Manager, Denials, Revenue Cycle, Telecommute, Telecommuting, Telecommuter, Work From Home, Work At Home, Remote, WAH, Sacramento, CA, California

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