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Recovery Resolution Consultant - US Telecommute
•30 days ago
| Hours | Full-time, Part-time |
|---|---|
| Location | Phoenix, AZ Phoenix, Arizona |
About this job
Position Description:
You'll join a high caliber team where you're assisting, educating, problem-solving and resolving tenuous situations to the best possible outcomes. Bring your people skills, emotional strength and attention to detail. In return we offer the latest tools and most intensive training program in the industry. Get ready to start doing your life's best work.
Recovery/Resolution Consultants are responsible for managing prospective claims savings to ensure cost avoidance financial goals are met. The Coordination of Benefits (COB) Recovery/Resolution Consultant high level focus is on the financial impact / cost savings to UHG, efficiency of COB processes, and compliance with state and federal requirements.
Primary Responsibilities:
You'll join a high caliber team where you're assisting, educating, problem-solving and resolving tenuous situations to the best possible outcomes. Bring your people skills, emotional strength and attention to detail. In return we offer the latest tools and most intensive training program in the industry. Get ready to start doing your life's best work.
Recovery/Resolution Consultants are responsible for managing prospective claims savings to ensure cost avoidance financial goals are met. The Coordination of Benefits (COB) Recovery/Resolution Consultant high level focus is on the financial impact / cost savings to UHG, efficiency of COB processes, and compliance with state and federal requirements.
Primary Responsibilities:
- Develop operational documentation that includes workflow use cases, context diagrams, requirements documents, operational support documentation, test cases and training material.
- Drive Coordination of Benefit (COB) business/regulatory requirements for all UHC business segments. Heavy focus on new business implementation and system migrations
- Monitor program monthly financial status by comparing and analyzing forecast saving against actual results to ensure financial goals are met;
- Seek out and lead project opportunities to drive the identification of new COB information and the improvement of COB processes.
- Take leadership and ownership of existing projects to maximize COB cost avoidance
- Work collaboratively with COB SMEs, operational teams and management, health plan representatives, and other external and internal partners;
- Lead internal/external vendor activity by driving work effort and/or providing Subject Matter Expert's (SME)
- Coordinate and monitor vendor and state file delivers to ensure other coverage information is loaded timely
- Coordinate vendor and state file reconciliation
- Track vendor and internal operational team quality of work, performing audits as needed;
- Audit and reconcile vendor invoices
- Work with internal operational teams (COB Ops) to manage cost avoidance loading and validation process.
- Research escalated COB issues and concerns, to identify root causes of problems or explain misinterpretations of COB outcomes
- Drive file crosswalk and/or mapping projects
- Represent department in IT and business initiatives
- Represent department in internal/external audits
- Research COB Encounter rejects
- Research cost avoidance reconciliation issues
- Research escalated COB issues and concerns, to identify root causes of problems or explain misinterpretations of COB outcomes
Requirements
Requirements:
- Bachelor's Degree or 5+ years of equivalent experience in work history
- 3 years Cosmos experience
- 3+ years of Business Analysis experience
- 3+ years of Medicare and Medicaid
Assets:
4+ years of project leadership experience- 3+ years of financial planning and forecasting
- 3+ years of Data Analytic
- 3+ years of heavy dependency on Excel
- 3+ years of experience working with relational database
Soft Skills:
- Must be able to thrive in a self-directed, matrix oriented environment
- Must work independently to prioritize duties and effectively multitask to meet conflicting deadlines
Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 14 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can do your life's best work.
Diversity creates a healthier atmosphere: 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.
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