Assistant Manager - Denial Management

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.

Primary Responsibilities:

• Candidate should be good in Denial Management
• Analysis data to identify process gaps, prepare reports
• Daily TAT and quality as per SLA
• Client handling experiences is Must. Need to co-ordinate with Clients and take an appropriate decision regarding operations
• Performing ongoing QC to ensure the client Quality SLA is met
• To ensure client satisfaction by the delivery of quality services and quality products
• Interacting with the client to understand and capture all requirements of the process
• Assisting Operations team to identify the potential areas of improvement and actively participate in improvement initiatives
• Maintenance of the Standard Operating procedures for all the processes
• Prepare and review the weekly and monthly Quality Dashboards with onshore and offshore stakeholders
• Conducting Quality feedback sessions and update the team on the findings

Team Management:

• To appraise the performance of the team members at the regular intervals
• Any existing team handling experience, assisting operations team to identify the potential areas of improvement and actively participate in improvement initiatives
• To identify the training needs of subordinates
• Train / Mentor the team on the quality concepts and identify the improvement areas
• Performing ongoing QC to ensure the client Quality SLA is met
• Recommend the rewards / incentives to the employees in token of the appreciation / recognition based on the performance
• Communicates well in front of groups, both large and small
• Ensure accurate and timely delivery of data to Team Liaison
• Build and maintain an effective Team environment
• Build and maintain effective relationships with internal customers (i.e. Team Liaison, US Team Leads/Supervisors)
• Perform Quality audits for the team and gap analysis for Denial Management
• Provide education to the team on updates and refresher sessions in a timely manner
• Provide feedback to management for individual team member and group training results
• Deliver/facilitate training (both new and ongoing)
• Review and update training materials as needed
• Analyze and develop overall improvement plans to the team members
• Administrative responsibilities as assigned
• Comply with the terms and conditions of the employment contract, company policies and procedures, and any and all directives
• (such as, but not limited to, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regards to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment). The Company may adopt, vary or rescind these policies and directives in its absolute discretion and without any limitation (implied or otherwise) on its ability to do so.

Required Qualifications:

• Graduate degree or equivalent experience
• 5 - 8 years of experience in US Healthcare BPO industry
• 5+ years of experience in AR Follow up and Denial Management
• Minimum experience in Grade 25 on collection specialist
• Hands-on experience in US Healthcare Revenue Cycle Management - AR Calling and Denial Management
• US Healthcare - Provider experience
• Solid in Account Receivable process. Exposure or experiences in Billing/charge and Payment posting will be added advantage
• Candidate should have knowledge of Medicare, Medicaid & ICD & CPT codes used on Denials
• Capability to handle onshore SME’s individually
• Solid Proficiency in MS Office
• Proven excellent Interpersonal skills
• Demonstrated ability to exceed performance targets
• Proven good communication Skills (both written & verbal)

Careers with Optum. Our objective is to make health care simpler and more effective for everyone. With our hands at work across all aspects of health, you can play a role in creating a healthier world, one insight, one connection and one person at a time. We bring together some of the greatest minds and ideas to take health care to its fullest potential, promoting health equity and accessibility. Work with diverse, engaged and high-performing teams to help solve important challenges.

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.

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