Recovery Resolution Consultant

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. 

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

The Recovery Resolution Consultant 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 Recovery Resolution Consultant will facilitate regular information sharing with Optum and client leadership. You will work with the Payer and client to review all proposed corrective actions plans and assure all action plans are implemented at the facility level. The role will have direct partnership with Denials and Expected Reimbursement to manage global projects identified through underpayments and Payer claims trending. This requires many meetings with Payers, PSR and collaborative workgroups to ensure cash acceleration and AR reduction of aging greater than 90 days.

This position is full-time Monday – Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00am – 5:00pm. It may be necessary, given the business need, to work occasional overtime.  

We offer 4 weeks of on-the-job training, The hours of training will be during normal business hours.

Primary Responsibilities:

• Prepare and present highly professional monthly Payer JOC and claims calls meeting with client PSR and engaged in settlements using Microsoft PowerPoint, Power BI, and Excel
• Act as project leader for Payer Solutions global initiatives as assigned by leadership
• Review problems to identify root-cause and proper handling of claims from beginning to end of life-cycle
• Identify opportunities for cash acceleration and prevention of Payer trends by collaborating with all departments and partners involved in the revenue cycle service lines
• Collaborate with operational leaders to develop solutions (using Six Sigma DMAIC methodologies)
• Analyze outcomes for trends and areas of opportunity. Triangulate with other Payers or government audit outcomes for both quantitative and qualitative executive summary reporting
• Collaborate with team members to address service area specific issues, barriers to improvements, share information and collaborate toward solutions
• Provide excellent customer service, resources and responsiveness to clients’ needs as they relate to denial management activities. Communicate concerns or issues on behalf of the client in relation to Payer performance, with the goal to expedite solutions and client satisfaction
• 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 Payer Meetings, denial Meetings with client PSR.
• Facilitate effective goal-oriented communication between client and Optum 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:

• High School Diploma/GED
• Must be 18 years OR older
• 3+ years of experience working with hospitals and operations professionals
• 2+ years of experience analyzing large data sets to identify trends, develop baselines, and track improvement 
• 2+ years of experience creating presentations demonstrating outcomes and presenting in-person or remotely to executive audiences
• 2+ years of experience in Healthcare Revenue Cycle including Payer engagement, PSR, Settlements and Payor Appeals
• 2+ years of experience working with Patient Financial Services, Business Office, Insurance billing Collections, Reimbursement, and Patient Access
• 2+ years of experience in Contractual Payer operations and/or process improvement methodologies
• 1+ years of experience with documenting processes and practices (process maps, job aids, instructions)
• Experience with Microsoft Word (create correspondence and work within templates), Microsoft Excel (data entry, sort / filter, and work within tables) Microsoft Outlook (email and calendar management), PowerPoint (deck creation, presentation)
• Ability to work full time Monday – Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00am – 5:00pm. It may be necessary, given the business need, to work occasional overtime.

Preferred Qualifications: 

• Six Sigma or Lean Sigma certification, training, or experience
• Demonstrated leadership skills, professionalism, organization, growth, and development of staff
• 2+ years of Project Management experience with an understanding of action items, next steps, assignment of tasks, measuring improvement, holding others accountable
• 2+ years of experience with government or non-government auditing and reimbursement
• Experience or confident ability to learn Microsoft Visio, Microsoft Power BI, SharePoint
• Advanced with Excel, PowerPoint, Word, Outlook with ability to build reports, presentations, spreadsheets

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.

Soft Skills:

• Demonstrated solid organizational skills

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy 

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you’ll find a far-reaching choice of benefits and incentives. The salary for this role will range from  $71,200 – $127,200 annually based on full-time employment. We comply with all minimum wage laws as applicable.

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.

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.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug – free workplace. Candidates are required to pass a drug test before beginning employment.