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Claims Denial Management Lead - North State or Sacramento, CA area

UnitedHealth Group

Sacramento, CA
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Job Details

732082 Claims Denial Management Lead North State or Sacramento CA area

Claims Denial Management Lead - North State or Sacramento, CA area (732082)

Position Description

If you're looking for a better place to use your passion and your desire to drive change, this is the place to be. It's an opportunity to do your life's best work.(sm)
You believe data can help reshape the future, and you find yourself loving the thrill of diving into challenging analysis. At UnitedHealth Group, you'll find an organization that will recognize those talents and have lots of growth potential. Here, you will be empowered, supported and encouraged to use your analysis expertise to help change the future of health care. Does the challenge intrigue you?
Optum360 is a dynamic new partnership formed by Dignity Health and Optum to combine our unique expertise. As part of the growing family of UnitedHealth Group, we'll leverage all our resources to bring financial clarity and a full suite of revenue management services to health care providers nationwide.
The Optum360 Service Area Denial Management Lead will provide denial management oversight and guidance to his/her designated service areas. This position is responsible for oversight of systemic trends through deep analytical analysis and facilitating process improvement that will minimize the fiscal impact of denials (including government audits). The Denial Management Lead will facilitate regular information sharing with Optum360 and client leadership. You will work with the client to review all proposed corrective actions plans and assure all action plans are implemented at the facility level.
Primary Responsibilities:
  • Monitor key performance indicators and established denial trend metrics for designated service area(s)
  • 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
  • Identify areas of deviance from system averages or expected best practice metrics
  • 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 other service area denial management leads to address service area specific issues, barriers to improvements, share information and collaborate toward solutions
  • Work with site stakeholders to facilitate their creation of a corrective action plan to address key issues
  • Monitor and report out progress of corrective action plans to clients and internal leadership
  • Monitor all 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; with the intent to provide meaningful information designed to effect operational changes toward efficiencies in care, improved revenue, and decreased denials and / or audits
  • Communicate project plans/ Action plans and trending to CFO/CEO client members monthly.  Be able to answer questions in regards to denials and how Denials Management drive change month over month

The Claims Denials Management Lead must be located in the North State or Sacramento, CA area.  This role requires at least 20% travel within the Greater Sacramento and North State area.

Required Qualifications:

  • 5+ years of experience working with hospitals and operations or clinical professionals
  • Experience with government or non-government auditing and reimbursement methodologies as well as denial management
  • Demonstrated experience driving change and holding accountable clinical and non-clinical facility personnel
  • 2+ 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)
  • Excellent Customer Service Skills
  • Demonstrated leadership skills, professionalism, organization, growth and development of staff
  • Ability to analyze data and draft summary presentations demonstrating outcomes

Preferred Qualifications:

  • Project Management skills
  • Clinical experience
  • Advanced Critical Thinking Skills
  • 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 Optum360. At Optum360, we're on the forefront of health care innovation. With health care costs and compliance pressures increasing every day, our employees are committed to making the financial side more efficient, transferable and sustainable for everyone. We're part of the Optum and UnitedHealth Group family of companies, making us part of a global effort to improve lives through better health care. In other words, it's a great time to be part of the Optum360 team. Take a closer look now and discover why a career here could be the start to doing your life's best work.(sm)


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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: Optum, Optum360, Revenue Cycle, Denial, Billing, Patient Financial Services, North State, Sacramento, CA, California

Job Details

  • Contest Number732082
  • Job TitleClaims Denial Management Lead - North State or Sacramento, CA area
  • Job FamilyBusiness Operations
  • Business SegmentOptumInsight

Job Location Information

  • Sacramento, CA
    United States
    North America
  • Other LocationsRedding, CA
    Shasta, CA

Additional Job Detail Information

  • Employee StatusRegular
  • ScheduleFull-time
  • Job LevelIndividual Contributor
  • 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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