JOB DESCRIPTION

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 diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

Primary Responsibilities:

• Analysis of data to identify process gaps, prepare reports
• Responsible for daily TAT and quality as per SLA
• Performing ongoing QC to ensure the client Quality SLA is met
• Ensure client satisfaction by the delivery of quality services and quality products
• Interacting with the client to understand and capture all requirements of the process
• Assisting Operations team to identify the potential areas of improvement and actively participate in improvement initiatives
• Maintenance of the Standard Operating procedures for all the processes
• Prepare and review the weekly and monthly Quality Dashboards with onshore and offshore stakeholders
• Conducting Quality feedback sessions and update the team on the findings
• People
  • Appraise the performance of the team members at the regular intervals
  • Identify the training needs of subordinates
  • Recommend the rewards / incentives to the employees in token of the appreciation / recognition based on the performance
  • Communicates well in front of groups, both large and small
  • Train / Mentor the team on the quality concepts and identify the improvement areas
• Current team handling responsibilities
  • Accurate and timely documentation of claims data
  • Ensure accurate and timely delivery of data to Team Liaison 
  • Build and maintain an effective Team environment
  • Build and maintain effective relationships with internal customers (i.e., Team Liaison, US Team Leads/Supervisors)
  • Perform Quality audits for the team and gap analysis for Denial Management
  • Be able to extract AR inventory PMS / reporting tools from and find denial trends and analysis
  • Provide education to the team on updates and refresher sessions in a timely manner
  • Provide feedback to management on individual and group training results
  • Deliver/facilitate training (both new and ongoing)
  • Review and update training materials as needed
  • Routinely analyze quality results to report error trends
  • Identify root causes of errors and opportunities for defect reduction
  • Analyze and develop overall improvement plans
  • Administrative responsibilities as assigned
• 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
• 5 – 8 years of experience in US Healthcare industry (AR / RCM Collections)
• 6+ years of experience in AR Follow up and Denial Management
• Hands-on experience in US Healthcare Revenue Cycle Management – AR Calling and Denial Management
• Client handling experiences.  Need to co-ordinate with Clients and take an appropriate decision regarding operations
• Knowledge of Medicare, Medicaid, commercial & ICD & HCPCS codes used on Denials
• Subject matter expert in AR follows up
• Very solid in Account Receivable process is a must. Exposure or experiences in Billing/charge and Payment posting will be added advantage
• Proven good in Denial Management
• Demonstrated ability to exceed performance targets
• Proven excellent communication skill (both written & verbal) / Interpersonal skills
• Proven solid proficiency in MS Office

Preferred Qualification:

• Knowledge of Home Infusion / Rx RCM business

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.