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Manager Recovery - Resolutions - Franklin TN
| Hours | Full-time, Part-time |
|---|---|
| Location | Franklin, TN Franklin, Tennessee |
About this job
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.
The Clinical Operations Supervisor
position oversees the following functions: claims processing, project
management, Medical and Reimbursement policy, staff
management/supervision, Medicare and Medicaid reimbursement
methodologies and human resources (including the ability to interview,
mentor and coach team members).
Primary Responsibilities:
- Supervise and oversee metrics and daily production for Clinical Investigators
- Ensure all internal/external customer business expectations are met
- Responsible for review and development of policy and procedures tailored to the clients/products
- -Ensure the cases are processed in accordance with reimbursement and medical policies
- Develop new processes and process maps for Clinical Operations
- Driving process improvements and increasing the teams overall productivity
- Ensure compliance with CMS and state regulations
- Responsible for the oversight of quality
- Recovery/Resolution Manager
- Responsible for investigating,
recovering and resolving all types of claims as well as recovery and
resolution for health plans, commercial customers and government
entities. - May include initiating telephone calls
to members, providers and other insurance companies to gather
coordination of benefits data. - Investigate and pursue recoveries and payables on subrogation claims and file management. Process recovery on claims.
- Ensure adherence to state and federal compliance policies, reimbursement policies and contract compliance.
- May conduct contestable investigations to review medical history. May monitor large claims including transplant cases.
- Manages and is accountable for professional employees and/or supervisors.
- Impact of work is most often at the local level.
Requirements
Requirements:
- High school diploma or GED
- Able to work an 8 hour shift between 8am & 6pm Monday through Friday
- 1+ years supervisory experience
- 1+ year experience developing a team and coaching to meet production needs
- 1+ year experience working within a claims or collection environment
- Intermediate level of MS Word, Excel and Outlook experience
Assets:
- Bachelors degree preferred
- Previous experience developing policies, procedures and business processes
Take the next step, online at: www.yourlifesbestwork.com
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.
Diversity
creates a healthier atmosphere: All qualified applicants will receive
consideration for employment without regard to race, color, religion,
sex, national origin, protected veteran status, or disability status.
UnitedHealth Group is
a drug-free workplace. Candidates are required to pass a drug test
before beginning employment. In addition, employees in certain positions
are subject to random drug testing.
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