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Denial Prevention, Associate Director - Sacramento, CA or Telecommute

UnitedHealth Group

Sacramento, CA
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Job Details

755452 Associate Director Denial Prevention Sacramento CA

Denial Prevention, Associate Director - Sacramento, CA or Telecommute (755452)

Position Description

Transforming health care for everyone takes a huge effort. But we never said major impact was easy. At UnitedHealthcare, We are working to create a system that is connected, aligned and more affordable for all involved. One that delivers high quality care, responsive to the needs of each person and the communities in which they live. And as part of the UnitedHealth Group family of businesses, we have the support and resources of a Fortune 6 industry leader to do so. As a Director of Strategic Initiatives, you'll lead mission critical initiatives that drive the development of national policy for a significant population. You'll develop competitive products that deliver more value and improved outcomes and will help transform the health care industry.

Primary Responsibilities:
  • Provide direct supervision and coordination for the Denial Liaison staff
  • Serve as primary point of contact between Client Service Executive team and Denial Liaison staff, and provide necessary support
  • Interface with all Optum 360 departments regarding operational approaches, issues and opportunities to enable denial mitigation, consistency, and efficiency across the Dignity client
  • Represent the Denial Liaison team through work with the Client Service Executive team, Optum 360 operations and the Dignity client to provide ongoing support and improvement in denial reduction efforts
  • Provide expertise regarding management of denials, denial reduction approaches, and denial prevention
  • Establish best practice approaches for consolidation and streamlining work of the Denial Liaisons
  • Collaborate with Business Intelligence to create and refine ongoing denial reporting and dashboards
  • Engage efficiencies to reduce rework, eliminate waste, and improve responsiveness of Denial Liaisons in service of the Dignity client
  • Work collaboratively with Optum360 Operations, Client Management and Dignity leaders to develop solutions for reduction of initial and final denials
  • Monitor key performance indicators for initial and final denials, facility cash, and accounts receivable and incorporate corrective actions in facility action plans
  • Review and refine monthly executive summary to accompany monthly reporting package
  • Oversight of facility specific action plans to assure adverse trends and key performance indicators are addressed monthly 
  • Presents denial status updates to leadership
  • Provide excellent customer service, resources and responsiveness to client’s needs as they relate to denial management activities; communicate concerns or issues on behalf of the client in relation to denial management performance, with the goal to expedite solutions and client satisfaction
  • Participate in monthly and ad hoc denial management meetings with Client Leadership and provide analysis to enable resolution
  • Recommend change/improvements in Facility policies and procedures driving denial root cause
  • Provide feedback to Optum360 Operations specific to causation of initial denial and root case
  • Work collaboratively with Optum360 Operations to facilitate actions needed to correct the root cause
  • Analyze outcomes for trends and areas of opportunity; triangulate with other denial or government audit outcomes for both quantitative and qualitative executive summary reporting.
  • Collaborate with stakeholders (e.g., senior leadership, Optum360 Operations, end users) to ensure consistent use and application of solutions across functions and teams
  • Utilize stakeholder (e.g., senior leadership, Optum360 Operations, end users) feedback and/or process performance information to identify potential continuous improvement opportunities.
  • Monitor vendor performance as it relates to Denial Management performance and Optum360 key initiatives
  • Facilitate effective goal oriented communication between client and optum360 Denial Management Unit leadership
  • Leads the Denial Liaison team to demonstrate sustained reduction in denials for areas in which solutions have been implemented
  • Travel to facilities required, may include up to 50% travel including overnight trips for direct oversight of team members and client interface
  • Reliable personal transportation required for local travel
Required Qualifications: 
  • 5 or more years of experience working with hospitals and operations or clinical professionals
  • 3 or more years of experience management oversight leading highly dynamic teams
  • 3 or more years of experience working within Utilization management, Revenue cycle management or a denial management and prevention role
  • Experience with government or non-government auditing and reimbursement methodologies as well as denial management
  • Experience driving change and holding accountable clinical and non-clinical facility personnel
  • 3 or more years of experience with documenting processes and practices 
  • Proficiency with Microsoft Office programs to build reports, presentations and spreadsheets (Intermediate ability with Excel, PowerPoint, Word)
  • Experience working in a fast moving matrix organization with responsibilities to challenging team and individual service level expectations
Preferred Qualifications:
  • Project Management skills
  • Advanced Critical Thinking Skills
  • Experience in billing, collections, or appeal writing

Soft Skills:

  • Excellent Customer Service Skills
  • Demonstrated leadership skills, professionalism, organization, growth and development of staff
  • Ability to analyze data and draft summary presentations demonstrating outcomes
  • Detail oriented and ability to effectively handle multiple priorities and deadlines
  • Excellent verbal / written communication and interpersonal skills
  • Ability to collaborate with others
  • Able to work independently in a fast pace environment
  • Self-motivated

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care 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)


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:  denials manager, healthcare, Sacramento, CA, California, Telecommute, Remote, Work from Home

Job Details

  • Contest Number755452
  • Job TitleDenial Prevention, Associate Director - Sacramento, CA or Telecommute
  • Job FamilyBusiness Operations
  • Business SegmentOptumInsight

Job Location Information

  • Sacramento, CA
    United States
    North America

Additional Job Detail Information

  • Employee StatusRegular
  • ScheduleFull-time
  • Job LevelDirector
  • ShiftDay Job
  • TravelNo
  • Telecommuter PositionYes
  • Overtime StatusExempt

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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