Manager, Medical Cost Recovery - Sunrise, FL

UnitedHealth Group is an innovative leader in the health and well-being industry, serving more than 55 million Americans. Through our family of companies, we contribute outstanding clinical insight with consumer-friendly services and advanced technology to help people achieve optimal health.

UnitedHealthcare, a UnitedHealth Group company, provides network-based health and well-being benefits and services for employers and consumers nationwide. We use our strength, diversity and innovation to improve the lives of the more than 18 million people who receive our unique products and services. And our endless pursuit for excellence in everything we do extends to your career as well. Join us today for an inspired and purposeful mix of professional growth opportunities and personal rewards.



Responsibilities:
Management, implementation and day to day performance of process activities related to Recovery and Audit Programs.
Manager of audit team, coordinating and managing all resources needed to fulfill the requirements of the core processes of claims, contract, fee schedule, and fraud and abuses audits.
These processes include the review of claims, contracts and fee schedules include the review of claims, contracts and fee schedules to identify processing, procedural, systemic and billing errors and practices leading to claims overpayments.
Actively communicate with external providers and vendors as well as various internal divisions to ensure that recovery opportunities are appropriately identified, pursued, and reported.
Provide support for the Regional Audit and Recovery Director, as well as key staff in region, regarding technical reimbursement issues and polices and procedures.
Manage staff and facilities through audit process collections of monies owed UHC based on analysis of claim data, provider contracts and reimbursement policies.
Identify and manage resources needed to ensure appropriate DSS, MARS, ATG or other reports are available to support audit activities.
Analyze data to identify root cause of payment inaccuracies.
Appropriately document findings and forward to appropriate internal division for resolution.
Validate all root cause of documentation prepared by Medical Cost Recovery Analysts.
Insure that documentation for all requested claims adjustments are consistent with Medical claims Recoveries Documentation Requirements.
Routinely communicate with Uniprise and track status of all requested adjustments.
Maintain databases and spreadsheets for analysis and reporting.
Implement vendor programs supporting audit and recovery efforts.
Routinely communicate with vendors to ensure performance expectations are being met.
Serve as a technical reimbursement advisor regarding reimbursement issues and policies and procedures to the Director of Audit and Recovery.


Job Requirements:

Qualifications:
Ability to:
analyze data to identify trends and issues.
make decisions and work independently.
manage multiple priorities.
Excellent written and verbal communication skills.
Demonstrated ability to develop and maintain effective working relationships with internal and external customers.
Expert project management skills.
Demonstrated organizational and personal influencing skills include the ability to manage across organizational boundaries and build consensus.
In-depth knowledge of managed care operations and products, the UHC organization and processes.
5 years minimum health plan experience in claims, contracting or reimbursement.
Extensive knowledge of:
medical coding, industry forms, P&Ps and reimbursement issues.
COSMOS or UNET, as well as desk top applications.
Working knowledge of key linkages, such as reimbursement, finance and contracting.
Previous managerial experience preferred.
Bachelors degree preferred, clinical finance, or accounting/or equivalent experience.

Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V.