Operations Manager - Patient Financial Services - Remote In Ca

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.

The Operations Manager PFS will manage the hospital Patient Accounting Business Office. This position is Remote in CA (supporting Bakersfield and Santa Cruz facilities) and responsible for facilitating daily operations of AR management, including coordination with hospital and organizational departments affecting billing processes as well as direct oversight of operational duties such as: billing, collections, cash posting and overall accounts receivable. This position is also responsible for managing and coordinating team efforts toward a specific service delivery function and provides coaching, feedback, and corrective action as needed, to service delivery team members. This role is also required to provide monitoring and achievement of service metrics as set by the organization.

If you are located witihin the state of CA you will have the flexibility to work remotely* as you take on some tough challenges.

Primary Responsibilities:

• Recognize and solve user gaps in understanding of processes and collection aspects. Develops and/or implements bottom-up strategies to improve operational performance
• Manage compliance of all federal, state and private insurance carrier requirements
• Foster an environment that promotes teamwork and positive communications within the service area and department
• Demonstrate importance of employee engagement by focusing on priority areas with meaningful action plans throughout the year
• Work collaboratively and strategically with the Revenue Cycle team to develop and operationalize processes and procedures, with continuous process improvement activities
• Establish and maintain effective working relationships with all stakeholders. Influence/negotiate with internal and external stakeholders to drive strategy execution
• Contribute to the ongoing performance management, to include quality assurance, production and process improvement activities
• Continually stays abreast of operational performance, identifies degradation in service levels and leads remediation of issues
• Conduct thorough and impartial investigations into issues raised through employee complaints to HR Director through the Internal Dispute Resolution program
• Manage client satisfaction levels and remediation of client dissatisfaction to drive increased NPS (Net Promoter System and Net Promoter Score) results
• Provide regular manager-to-team communication and provides a forum where information about the department is shared and cascaded in a timely manner
• Proactively monitors and takes corrective action as needed to ensure operational performance metrics meet and/or exceed contractual terms and/or the criteria to achieve performance guarantees. As needed, participates in client meetings and reviews operational performance metrics
• Manage client satisfaction levels and remediation of client dissatisfaction to drive increased NPS (Net Promoter System and Net Promoter Score) results
• Demonstrate and maintain understanding of state, federal and third-party regulatory requirements as they apply to billing operations (e.g., Health-care reform, state surcharges, CMS)
• Effectively utilize all reimbursement tools including payer contracts and all relevant electronic claims processing and reimbursement tools
• Demonstrate, maintain understanding and comply with hospital/clinic billing policies and procedures
• Review and enhance claims for accuracy and performs edits as needed. This includes verification coding, demographic, eligibility, benefits, authorization, and billing requirements
• Support team with unresolved issues preventing timely claim submission or collections
• Partner with insurance companies regarding payment, denials and any discrepancy in processing of claims
• Conduct an appeal/inquiry to Insurance companies when needed
• Participate in Health Plan meetings and training opportunities
• Identify and support with resolution of payer trends and denials
• Independently work special projects as assigned
• Develop solid understanding of payer rules, provider manuals and contracts

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:

• 5+ years hospital revenue cycle experience
• 1+ years management experience
• Working knowledge of CPT (Current Procedural Terminology), HCPC (Healthcare Common Procedure Coding) and Government and Commercial regulations
• Knowledge of billing systems and billing requirements for-Government and non-government payers
• Knowledge and understanding of transaction reconciliation and refund policy and procedures
• Proficient with Microsoft office
• Proven ability to organize by being proactive in prioritizing needs and effectively managing resources
• Proven effective communication skills, leadership, and customer orientation. Able to work with both onshore and offshore partners
• Ability to travel up to 10%

California Residents Only: The salary range for this role is $88,000 to $173,200 annually. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. 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.