Denial Process Consultant - Remote

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.

You believe data can help reshape the future, and you find yourself loving the thrill of diving into challenging analysis. At UnitedHealth Group, you'll find an organization that will recognize those talents and have lots of growth potential. Here, you will be empowered, supported, and encouraged to use your analysis expertise to help change the future of health care.  

The Optum Denial Process 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 Denial Process Consultant will facilitate regular information sharing with Optum and client leadership.You will work with the 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 Payor Solutions and Expected Reimbursement to manage global projects identified through underpayments and denial trending. This requires many meetings with CFOs and collaborative workgroups to ensure denial reduction. 

You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. 

Primary Responsibilities:

• Prepare and present highly professional monthly Denial Management presentations for client CFOs using Microsoft PowerPoint, Power BI, and Excel
• Act as project leader for Denial Mgmt global initiatives as assigned by leadership 
• Review denials to identify root-cause and proper handling of denials from beginning to end of life-cycle
• Identify opportunities for denial prevention by collaborating with clinical facility department and 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 denial 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 denial management 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 Denial Meetings with client CFOs
• 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.

Years of post-high school education can be substituted/is equivalent to one year of experience.

Required Qualifications:        

• 5 years of experience working with hospitals and operations or clinical professionals
• 5 years of experience analyzing large data sets to identify trends, develop baselines, and track improvement
• 5 years of experience creating presentations demonstrating outcomes and presenting in-person or remotely to executive audiences
• 3 years of experience in Healthcare Revenue Cycle including Denials Management and Payor Appeals
• 3 years of experience working with Patient Financial Services, Business Office, Insurance claim billing, Collections, Reimbursement, Patient Access, Coding
• 3 years of experience in denial prevention operations and/or process improvement methodologies
• 3 years of experience presenting to executive level audiences
• 3 years of Project Management experience with an understanding of action items, next steps, assignment of tasks, measuring improvement, holding others accountable
• 3 years of experience with documenting processes and practices (process maps, job aids, instructions)
• 2 years of experience with government or non-government auditing and reimbursement
• Advanced with Excel, PowerPoint, Word, Outlook with ability to build reports, presentations, spreadsheets, and process maps
• Some experience or confident ability to learn Microsoft Visio, Microsoft Power BI, SharePoint
• Demonstrated leadership skills, professionalism, organization, growth, and development of staff
• Solid organizational skills
• Ability to telecommute, work independently, and travel to west coast as needed (25-50%) 

Preferred Qualifications:        

• Six Sigma or Lean Sigma certification, training, or experience 
   

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

California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Rhode Island, or Washington Residents Only: The salary range for California/Colorado/Connecticut/Hawaii/Nevada/New Jersey/New York/Rhode Island/Washington residents is $88,000 to $173,200 annually. 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 incentives.

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. 

Diversity 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.