Supervisor - Healthcare Claims Recovery Resolution - Ontario, CA
Location: Ontario, CA
The Recovery Resolution Supervisor is responsible for supervising the staff, setting goals for the team, providing process development, project management, leadership, mentoring, and training within the Revenue Recovery department.
- Oversight for multiple areas of responsibility within the Revenue Recovery department; including claims auditing, billing and recovery of claims overpayments, investigating and pursuing recoveries and payables on Subrogation cases (Third Party Liability and Workers Comp)
- Responsible for working with the team and setting up overpayment identifiers to monitor timely and accurate job tasks
- Identify new recovery potential and develop plans to meet the short term objectives as needed by the department
- Document and communicate outcomes of claims investigation to all applicable internal and external stakeholders to facilitate resolution of overpayments
- This candidate is expected to work as an integral member of the Revenue Recovery Management Team to identify, resolve, and apply close gap measures for all operational issues using defined processes, expertise and judgment
- Oversight of the design and implementation of system automation for the department
- Monitor and reconcile billing and recovery data in applicable systems
- Participate in management level meetings
- Prepare and report the month-end financials for the Revenue Recovery department
- Perform other duties as assigned
- 8-10 years of working experience in Managed Health Care
- 3-5 years in a management/supervisory role
- Working knowledge of Claims, Financials, Healthplan and Provider Contracts (DOFRs, Compensation rates etc.), Subrogation and Stop Loss Reinsurance
- Experience interpreting and negotiating Managed Care Excess Loss Insurance Policy
- Intermediate proficiency in Microsoft Excel and Access with working knowledge of SQL
- Bachelor degree in Accounting/Finance preferred
- Knowledge and experience in ICD-10 and HCPC coding
- Experience working with high volume of claims data
- Exceptional analytical and communication skills
- Strong analytical and problem solving skills, comfortable with complex calculations and strong attention to detail
- Capable of working with minimal supervision exercising independent judgment within the scope of knowledge
Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.SM
North American Medical Management, California, Inc (NAMM California) partnered with OptumHealth in 2012. NAMM California and OptumHealth share a common goal of bringing patients, physicians, hospitals and payers closer together in the mission to increase the quality, efficiency and affordability of care. NAMM California is a part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system. NAMM California develops and managers provider networks, offering a full range of services to assist physicians and other providers in supporting patient care coordination and their managed care business operations. For over 18 years, NAMM California has been an innovator in health care with a track record for quality, financial stability, extraordinary services and integrated medical management programs. NAMM California is well positioned to continually invest in its infrastructure and systems for the benefit of its provider clients and to accommodate the impending changes that will come forth from healthcare reform.
The NAMM California provider clients represent a network of almost 600 primary care physicians and over 3,000 specialists and work with the premier hospitals in their respective markets.
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.
Job Keywords: Revenue Recovery, Managed Care, Healthcare, Supervisor, Manager, claims audit, Subrogation, Stop Loss Reinsurance, Excel, Access, SQL, HCP-10, HCPC coding