[Hiring] Recovery Resolution Consultant @UnitedHealth Group

Role Description

This position is National Remote. You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

The Recovery Resolution Consultant for Payment Integrity operations will serve as the operational expert for payment integrity programs. The recovery resolution consultant will aid in vendor implementations, vendor management and deliver daily operational functions. They will act as the subject matter expert for their function. Daily activities include:

• Verification of claims payment accuracy
• Providing state and federal policy expertise
• Data analysis
• Ensuring adherence to state and federal compliance policies, reimbursement policies, and contract compliance
• Investigation and recovery of claims overpayments
• Analytic rule validation and approval

The recovery resolution consultant will need to work with numerous matrix partners to manage deliverables, provide policy expertise, communicate change, and manage escalations.

This position is full time, Monday - Friday. Employees are required to have flexibility to work any of our shift schedules during our normal business hours of 8:00 am - 4:30 pm EST. It may be necessary, given the business need, to work occasional overtime.

This will be paid training. The hours of the training will be based on schedule or will be discussed on your first day of employment.

Primary Responsibilities:

• Functional process support for operations relating to the delivery of Payment Integrity
• Provide claim process and reimbursement methodology expertise
• Develop strong partnership with matrixed partners and stakeholders
• Perform complex data analysis
• Collaborate with a wide variety of matrix partners including but not limited to; network management, claims operations, compliance, regional and national medical directors, internal and external vendors, UHC, OGA
• Coordinate with vendors to review and approve analytics that identify claims overpayments
• Leverage claims processing system to research and validate overpayments
• Coordinate with claims operations to submit claims overpayments and adjust in system & track to completion
• Self-manage assigned tasks and deliverables to achieve set targets
• Ensure that operational processes are standardized across multiple vendors and internal programs
• Document and communicate outcomes of claims investigations/overpayment/prepayment reviews
• Manage multiple line of business with varying regulations and compliance rules
• Collaborate with claim operations and peer PI teams to identify ‘shift left’ opportunities
• Manage and solve issues, escalations and complex problems applicable to assigned PI programs
• Demonstrate understanding of applicable federal, state, and local compliance regulations (e.g., DOI, DOL, Healthcare Reform/PPACA, CMS) and ensure adherence
• Manage, document, and prioritize workload in accordance with established targets
• Achieve assigned operational targets; TAT, appeal, savings
• Act as subject matter expert to identify quality improvement opportunities
• Ideate and identify new opportunities for assigned programs

Qualifications

• High School Diploma / GED OR equivalent work experience
• Must be 18 years of age OR older
• 3+ years of healthcare operations experience
• 3 + years of experience working within a health plan and / OR managed care business operations
• 3+ years of payment integrity experience: prepayment and / OR post-payment processes
• Experience coordinating and navigating complex matrixed organizations
• Data analysis and claims payment expertise
• Track record of providing coaching and mentorship

Requirements

• Experience in aberrant billing detection, analytic methodologies, payment policies, and / OR provider contracts
• Medical coding OR clinical experience and / OR certification (e.g., CPC, CCS, RHIA)
• Vendor management experience
• FACETS experience

Telecommuting Requirements

• Ability to keep all company sensitive documents secure (if applicable)
• Required to have a dedicated work area established that is separated from other living areas and provides information privacy
• Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution (all benefits are subject to eligibility requirements)

Application Deadline

This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.