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 analysis on 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)
Possess a Strong knowledge of US Health care and Should have knowledge of AR, CE, CB and PP LOB
Measuring and tracking team performance
Provide feedback to team members on a regular basis
Review and update process SOP’s/documents as needed
Should have fair understanding of UB04 & HICFA 1500 claim forms
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)
Minimum of 5 years of experience in Team Handling (Min Span of 18 – 20 people)
5 or more years in US health care and/or AR claim experience
Sound knowledge of RCM (AR, PP & CB)
Extensive knowledge of NextGen, Allscripts, Epic as well as desk top applications
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
Good analytical skills
Excellent written and verbal communication skills
Possess a 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
Demonstrate the ability to communicate effectively both verbally and in writing
Ability to analyze data to identify trends and issues
Ability to make decisions and work independently
Open to Night Shifts
Careers with Optum. Our objective is to make health care simpler and more effective for everyone. With our hands at work across all aspects of health, you can play a role in creating a healthier world, one insight, one connection and one person at a time. We bring together some of the greatest minds and ideas to take health care to its fullest potential, promoting health equity and accessibility. Work with diverse, engaged and high-performing teams to help solve important challenges.
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.