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 togetherPrimary Responsibilities:

• Manage overall personnel, performance, and discipline of the audit team members for different processes
• Provide expertise and leadership in assigned functional area
• Manage relationship with internal stakeholders and functions
• Manage all client interaction and client communication and have front end the relationship with the client
• Periodic review and analysis of all reports and metrics
• Provide support to the Production Team and Supervisors to continually improve their performance and meet Service Level Agreements/Performance Guarantee goals
• Evaluation of operational practices and procedures
• Provide support to quality initiatives targeted towards process improvements
• Be actively involved in the internal audit support; ensure all compliance parameters are met
• Establish and maintain a working environment conducive to positive morale, individual style, quality, creativity, and teamwork
• Provide direction to staff; ensure resolution of problems; set priorities
• Actively provide inputs and assistance to the senior management in the planning, implementation, and evaluation/modifications to existing operations, systems, and procedures, specifically relating to his/her assigned project(s)
• Manage attrition and building retention strategies
• Preparation of annual business plans including operating budgets
• Negotiate solutions, resolve conflicts and anticipate/handle critical situations
• Provide regular performance feedback and give frequent formal and informal coaching sessions
• Work with business partners to identify ways to improve business processes
• 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

EligibilityTo apply to an internal job, employees must meet the following criteria:

• Performance rating in the last common review cycle of Meets Expectations or higher
• Not be on any active CAP (Corrective Action Plan) or active disciplinary action
• Time in Role Guidelines - Should have been in your current position for a minimum of 12 months, if you have not met the recommended minimum time in role, discuss your career interest with your manager and gain alignment prior to applying.
• And share the alignment email with respective recruiter while applying
• Employee should be at the highest level of the current grade to apply for the next grade

Required Qualifications:

• Bachelors degree with US Healthcare provider experience, specifically in A/R recovery/Payment posting/Billing (RCM - Revenue Cycle Management services)
• Should possess PMP certification or should have completed GB training/certification
• 15+ years of experience on RCM- Backend operations
• 8+ years on handling denial Management and credits
• 8+ years of experience in handling large teams
• Expert in preparation of excel reports and PowerPoint presentations
• Demonstrate the ability to communicate effectively both verbally and in writing. Attention to detail and demonstrate the ability to perform deep dive AR analysis
• Ability to multi-task and prioritize in order to complete daily tasks with minimal supervision
• Working knowledge of budgeting, cost estimating, capacity utilization principles and procedures

Preferred Qualifications:

• Proven ability to review and handle appropriately:

• Knowledge on Pharmacy (Home Infusion) billing concepts & collections
• Familiar with payer contracts and approach
• Proven capability to co-ordinate with payer advocates and resolve AR
• Adhere to quality improvement initiative
• Special projects execution as required
• Proven calibration process:

• Able to actively participate on calibration and collaborate with support functions
• Able to give correct resolution of agenda asked by operations
• Able to handle and give justification of rebuttals if required

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