Resolution and Appeals Divisional Escalation Manager - Remote
Company: UnitedHealth Group
Location: Hartford
Posted on: May 14, 2022
Job Description:
You'll enjoy the flexibility to telecommute* from anywhere
within the U.S. as you take on some tough challenges. Combine two
of the fastest - growing fields on the planet with a culture of
performance, collaboration and opportunity and this is what you
get. Leading edge technology in an industry that's improving the
lives of millions. Here, innovation isn't about another gadget,
it's about making Healthcare data available wherever and whenever
people need it, safely and reliably. There's no room for error.
Join us and start doing your life's best work.SM*All Telecommuters
will be required to adhere to UnitedHealth Group's Telecommuter
Policy.Primary Responsibilities:The Itemized Bill Review,
Resolution and Appeals Divisional Escalation Manager is primarily
responsible for the following, but not limited to:
- Lead Equian Itemized Bill Review on all liability efforts that
support the Forensic Review, including all verbal and written
communications with internal and/or external parties. - -
- Management and successful closure of escalated claims that
require client involvement
- May also have an assignment of other claims and is responsible,
for guiding these claims to a successful close. -
- Serve as Itemized Bill Review escalated Subject Matter Expert
("SME") and acts as a trainer / mentor for the Itemized Bill Review
business. - SUBORDINATE JOBS - - Including their Basic
FunctionN/AESSENTIAL FUNCTIONS*: * Denotes "essential functions" in
accordance with the guidelines of The Americans with Disabilities
Act. - The essential functions of this position include, but are
not necessarily limited to, those specifically identified in this
description. - The position and its essential functions may change
over time, and these changes may not necessarily be reflected in
the position description. - The Company may, at its sole
discretion, add to, change, or expand the essential or marginal
functions of the position.Claims
Resolution/Negotiation/Documentation/Complex Claim Support
- All CRR business liability strategies and/or high liability
escalations with both the Client and Provider (includes their
necessary travel and representing the Company and Client) -
- Providing Clients, a supported template response to Provider's
inquiries regarding adjustments (e.g. Clean Claim / Prompt Pay
Language)
- Lead the resolution effort for escalated claims, including all
verbal and written communications with clients, facilities, and
third parties, to include returning calls and emails in a timely
manner
- Provide analysis and recommendations to client, based on
client-specific guidelines and provider information, to apply an
optimal resolution strategy for outstanding issues, including the
identified adjustments, application of out-of-network discounts,
appeal timeline, facility guidelines, and any other appropriate
parameters
- Coordinate and interact with the Clinical, Appeals, Account
Management, Operations Management, and Legal teams as needed
throughout the Resolution and/or Appeals process
- Adhere to Key Performance Indicators as implemented by the
Director of Resolution, Appeals and Quality Division
- Update and document claim status, notes, and information in
Equian systems and ensure documentation is accessible to others
also working on the claim (for example, HANDS, Clinical Point,
etc.)
- Maintain open communication with client on resolution matters
in accordance with client's requirements to obtain a resolution
that is acceptable to the client
- Coordinate updating the Forensic Review Report and related
documents and systems to ensure the revised adjustments are
reflected in the record for accounting purposes; includes
facilitating revisions to Forensic Review Reports, updates to
accounting fields, and/or claim related documentation
- Communicate client issues, as warranted, with the assigned
Account Manager, Account Coordinator, Appeals, and any other
individuals also involved in the issue
- Act as consultant to the Appeals and the Resolution Departments
and assist with work assignments as requested
- Attend and participate in escalated provider calls as requested
by Account Management or other teams
- Participate in updating proprietary policies and procedures as
applied by the Clinical team for claim reviews -
- Participate in the review of Client Provider Manuals,
Reimbursement/Payment Policies and/or Medical Policies when
warranted
- Lead and identify and escalate claims throughout Resolution
and/or Appeals process -
- Assist RAD team members as Divisional SME with work assignments
as requested
- Travel to provider or client meetings, as warrantedOther
- Understand, maintain, and always apply HIPAA privacy and
security standards
- Apply Company's business rules and regulations to all
interactions with clients, facilities, and third parties
- Contribute to development of and enhancements to the Company's
business systems
- Contribute to development of and enhancements to the Company's
process improvements
- Participate / Contribute to legal / regulatory investigations
as warranted
- Participate in department, Company, and client meetings as
required
- Serve as a Company CRR SMEYou'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:
- High School Diploma / GED (or higher)
- 5+ years of progressive business experience preferably in a
healthcare managed care administration environment.
- Demonstrated success in the areas of provider relations, claim
negotiation and resolution required.
- 8+ years of experience in medical billing/coding, claims
review, and appeals
- 8+ years of experience in Appeals/Health Insurance Regulatory
Affairs
- Knowledge of medical and insurance terminology
- Experience in lead position -Preferred Qualifications:
- Juris Doctorate or RN Degree; emphasis in healthcare billing,
accounting, finance, law or business administration preferred.
-
- Familiarity with medical terminology and coding
- Advanced computer skills, specifically Microsoft Excel (create,
edit, save and send spreadsheets)Soft Skills:
- Strong organizational skills, attention to detail, and ability
to prioritize
- Excellent analytical skills
- Ability to multi-task and work with little direction. - A
self-starter.
- Excellent verbal and written communication skills.
- Proven strategic negotiation skills.
- Strong organizational skills, attention to detail and ability
to prioritize.
- Ability to multi-task and work with little direction.
- Team player demonstrating enthusiasm and commitment to Company
vision and mission.
- Strong customer service and relationship building
skills.Telecommuting Requirements:
- Required to have a dedicated work area established that is
separated from other living areas and provides information
privacy
- Ability to keep all company sensitive documents secure (if
applicable)
- Must live in a location that can receive a UnitedHealth Group
approved high-speed internet connection or leverage an existing
high-speed internet serviceUnitedHealth Group requires all new
hires and employees to report their COVID-19 vaccination
status.Military & Veterans find your next mission: We know your
background and experience is different and we like that.
UnitedHealth Group values the skills, experience and dedication
that serving in the military demands. In fact, many of the values
defined in the service mirror what the UnitedHealth Group culture
holds true: Integrity, Compassion, Relationships, Innovation and
Performance. Whether you are looking to transition from active duty
to a civilian career, or are an experienced veteran or spouse, we
want to help guide your career journey. Learn more at Learn how
Teresa, a Senior Quality Analyst, -works with -military veterans
and ensures they receive the best benefits and experience possible.
-Careers with OptumInsight. Information and technology have amazing
power to transform the Healthcare industry and improve people's
lives. This is where it's happening. This is where you'll help
solve the problems that have never been solved. We're freeing
information so it can be used safely and securely wherever it's
needed. We're creating the very best ideas that can most easily be
put into action to help our clients improve the quality of care and
lower costs for millions. This is where the best and the brightest
work together to make positive change a reality. This is the place
to do your life's best work.SMColorado, Connecticut or Nevada
Residents Only:The salary range for Colorado residents is $64,800 -
$116,000. The salary range for Connecticut / Nevada residents is
$71,400 - $127,400. 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 incentivesDiversity 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.Keywords: UnitedHealth Group,
UnitedHealthcare, Optum, health care, office, phone support,
customer service, billing, training class, now hiring, jobs,
career, work at home, work from home, WAH, WFH, remote,
telecommute, hiring immediately, #RPO
Keywords: UnitedHealth Group, Hartford , Resolution and Appeals Divisional Escalation Manager - Remote, Executive , Hartford, Connecticut
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