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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

The Manager of Denials Management reports to the Associate Director of AR - East. This role is responsible for leading the denial management process within a large, high volume multi-specialty setting.  Their mission is to identify, resolve, and ultimately prevent denied healthcare claims in order to maximize timely reimbursement.

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

Primary Responsibilities:

• Lead the denial management team: Guide and manage a team of supervisors, analysts and specialists to analyze and address claim denials from insurance providers
• Develop denial prevention strategies: Implement proactive measures and processes to root cause and assist in development of action plans to eliminate future claim denials
• Manage the appeals process: Ensure timely follow-up and resolution of denied claims, including preparing and submitting appeals with compelling arguments based on medical records and payer policies
• Monitor and analyze denial trends: Track denial data, identify patterns and root causes, and provide regular reports to management and other stakeholders
• Collaborate with other teams: Work closely with billing, coding, and clinical teams to identify the sources of denials and implement corrective actions
• Stay updated on industry regulations and coding updates: Ensure compliance with payer policies and guidelines to prevent denials
• Train and mentor staff: Develop and deliver training programs on best practices for denial resolution and appeals strategies
• Implement process improvements: Streamline denial management workflows and enhance efficiency within the department
• Achieve and maintain Key Performance Indicators (KPIs): Work with the revenue cycle management team to meet departmental goals and objectives

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:

• Bachelor's degree in business or healthcare administration or equivalent experience
• 5+ years of medical insurance/healthcare revenue cycle experience with a deep understanding of medical billing rules and regulations
• 3+ years of supervisory/leadership experience
• EPIC system knowledge  
• Knowledge of professional fee billing, reimbursement/third-party payer regulations and medical terminology
• Intermediate proficiency with Excel, PowerPoint, Word. Knowledge of computer systems, including use of spreadsheets and database programs
• Proven ability to educate and train all levels of professional staff
• Proven ability to recognize individual and team accomplishments; to empower individuals and teams
• Proven solid problem-solving ability, critical thinking, and analytical skills 
• Proven excellent analytical and problem-solving skills
• Proven excellent organizational skills
• Proven ability to take direction from senior leadership but also be able to work independently with follow-through and handle multiple tasks simultaneously
• Proven ability to be proactive, self-direct, and take initiative
• Proven ability to work efficiently under pressure
• Proven ability to set priorities and use good judgment

Preferred Qualifications:

• Certifications: Certified Denial Recovery Specialist (CDRS), Certified Medical Reimbursement Specialist (CMRS), Certified Professional Coder (CPC)
• Medicare, Medicaid and/or Commercial FFS billing experience
• Experience and understanding of ICD10 and CPT codes

• Knowledge of HIPPA Practices and Regulations

   

• Solid understanding of accounting principles, fair credit practices and collection regulations

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

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $71,200 to $127,200 annually based on full-time employment. We comply with all minimum wage laws as applicable.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

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 is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.