Position Description:Healthcare isn't just changing.It's growing more complex every day. ICD-10 Coding replaces ICD-9. AffordableCare adds new challenges and financial constraints. Where does it all lead?Hospitals and Healthcare organizations continue to adapt, and we are vital partof their evolution. And that's what fueled these exciting newopportunities. Who are we? Optum360.We're a dynamic new partnership formed by Dignity Health and Optum to combineour unique expertise. As part of the growing family of UnitedHealth Group, we'll leverage our compassion, our talent, ourresources and experience to bring financial clarity and a full suite of RevenueManagement services to Healthcare Providers, nationwide. If you're looking for a better place to use yourpassion, your ideas and your desire to drive change, this is the place to be.It's an opportunity to do your life's best work.Provides a full range of duties to support all members of the Clinical Appeal teams within the Denial Management Unit. Participates in a wide range of activities associated with technical and clinical appeals; including, but not limited to, verifying accuracy and completeness of denials and tracking denial / appeal activity in the electronic system throughout the life cycle of the denial. Also includes managing the referrals process and processes incoming and outgoing referrals. Primary Responsibilities:Access claims information to review, analyze all denials for payments and / or recoupments that come into the Clinical Appeal Unit to ensure appropriate designation as a clinical appealRe-route inappropriate denial referrals to the Clinical Appeal Units to the appropriate departmentsProvide accurate denial information to the Clinical Appeal Units (i.e. dates denied, reason for denial, timely filing date, appeal address, and forms that need to be attached to the appeal) Understand and articulate the client appeal rights for all payorsMaintains strict adherence to appeal requirements and associated timeframesTimely completion of all assigned tasks within appeal software with consistently accurate resultsMaintain communication with all Payors and provide follow-up activity as necessary to secure information regarding payment, recoupments, denials, appeal response, and clarification of correspondenceManage and maintain all referrals to EHR (submit referral form, facilitate submission of medical records, download appeal letters, notify EHR of appeal status updates, and document case progress in appropriate electronic system)Provide reconciliation findings and escalate any trends or items of concernMaintain database information relative to financial activityProvide account detail updates to the appropriate systems as necessaryMonitor vendor portals / websites for documents related to all clinical appealsIdentify solutions to non-standard requests and problemsProvide administrative support for submission of appeals including copying of medical records, mailing our appeal packets, and scanning documents into electronic system. Provide administrative support to remote workers within the Clinical Appeal UnitsProcess / Scan / document correspondence received in Clinical Appeal Units
Required Qualifications: High School Diploma / GED (or higher) Proficiency with Microsoft Office including Word (create and edit documents), Excel (input data), Outlook (manage email), and the internet (navigating web) Knowledge of government and non-government medical financial programs (Medicare, Medicaid or Managed Care) or previous insurance experiencePreferred Qualifications: Associate's Degree (or higher) 2+ years of experience with Collections / Billing or Payor equivalent2+ years of previous Healthcare experience in Patient Financial Services Proficiency with Microsoft PowerPoint (create and edit presentations) Knowledge of Medical Terminology Experience in Utilization Management, Case Management, Appeals and / or Managed CareSoft Skills: Effective and accurate oral and written communication skills. Self motivated, detailed and organizedCareerswith OptumInsight. Information and technologyhave amazing power to transform the Healthcare industry and improve people'slives. This is where it's happening. This is where you'll help solve theproblems that have never been solved. We're freeing information so it can beused safely and securely wherever it's needed. We're creating the very bestideas that can most easily be put into action to help our clients improve thequality of care and lower costs for millions. This is where the best and thebrightest work together to make positive change a reality. This is the place todo your life's best work.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.Keywords: UnitedHealth Group. Denial Coordinator, Rancho Cordova, California, Medicaid, Medicare, Managed Care, collections, appeals, healthcare
Our mission is to help people live healthier lives and to help make the health system work better for everyone.- We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities. - We work with health care professionals and other key partners to expand access to quality health care so people get the care they need... at an affordable price. - We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions.