Manager, Revenue Recoveries

NAMM California
August 5, 2016

North American Medical Management, California, Inc (NAMM California) partnered with OptumHealth in 2012. We are currently hiring for the following positions in our Ontario office:

If you want to achieve more in your mission of health care, you have to be really smart about the business of health care. Challenge yourself, your peers and our industry by shaping what health care looks like and doing your life's best work.(sm)

Provide process development, project management, company liaison, leadership, mentoring and training on multiple areas within Revenue Recovery. Dept. has an average of 700 job tasks per year. Manager is responsible for monitoring timely and accurate job task completion, process development and automation, policy & procedures, and regulatory compliance within dept, inside and outside written communications for the fast paced and highly regulated TPL Dept. The Revenue Recovery Dept. has varying staff of 7 to 12 serving 16 IPA's over 3 Regions.

Areas of responsibility include program and process implementation and oversight, payment integrity processes and reporting to Optum, hospital risk cost assessment, multiple areas of reconciliation and auditing, reporting, policy negotiation, billing and recoveries for Stop Loss Reinsurance, HMO Risk Settlements, Capitation Reconciliations, Third Party Liability billing and recoveries, Class Action Lawsuits, AIM audits & chart review, Vendor Focus Audits, Claims Data Mining, Retro Term billings, HMO and Group claims leakage, COB/Hospice posting and billings, Cap Deductions, High dollar check review, High dollar billing review, Billable Services and financial analysis and contract support of shared risk PMPM costs, future budget projections for funding needs, and pharm / bio PMPM cost.

To produce high quantity and quality work, data review and analysis, to seek and identify new and existing recovery potential for the IPA's and Regions for the Revenue Recovery Dept. and highly regulated Third Party Liability program. To provide necessary information and back-up support top to Administration as needed. Participation in management level meetings for the purpose of representation and integration of new and terminating products, systems, groups, into and out of Revenue Recovery production plans.

Primary Responsibilities:

Project Management, System Development, Billings and Recoveries: 

  • Data analysis and monitoring always seeking new recovery potential for the IPA’s and Regions for implementation within the Revenue Recovery Department
  • Design and implementation of system automation for department
  • Annual dept. budget set-up and auditing
  • Financial analysis and contract support of shared risk PMPM costs, future budget projections for funding needs, and pharm/bio PMPM cost
  • Coordinate P&P and communications of highly regulated Third Party Liability Unit
  • Assist in the assessment and filing of Class Action Law Suits with Legal Department

Management of Personnel:

  • Hiring, firing and any documented disciplinary actions
  • Produce annual goal planning and documentation for collective dept. and each staff member individually
  • Adhoc job assignments for each staff member, with at least weekly monitoring
  • Annual reviews
  • Apply close gap measures for all audit findings, provide oversight, mentoring and training
  • Meet with various staff weekly (based on project due dates) for discussion on project progress, road blocks, assistance on process and provide any tools and input needed
  • Prepare Dept. payroll bi-weekly
  • Manage misc. HR issues for staff

Management of Reports and Programs:

  • Develop process for project tracking, review reports for effective, timely and accurate project Prepare completion
  • Monitor reports of revenue recoveries and savings
  • Reinsurance historical summary to reflect collection ratio per policy per year
  • Generation and maintenance of reports on all outstanding Health Plan issues
  • Shared risk reporting for all outstanding Health Plan and Hospital Issues
  • Develop and Monitor TPL reports for variance analysis for any potential process changes
  • Review RR reporting and reconciliations for compliance, completeness and accuracy

Management, Other:

  • Company liaison for payment integrity processes and reporting to Optum.  Review outsourcing opportunities for fullest recovery opportunities for the company
  • Interact with contracting, claims, provider services, configuration, eligibility, capitation, member services and UM on recovery efforts, close gap measures, new processes for increased recoveries
  • Intermediary to HMO’s for resolution of large and/or longstanding issues
  • Intermediary to AIM, High Desert Creditor consultants
  • Intermediary to outside auditors on dept. processes and recovery efforts
  • Intermediary to Attorney’s for Arbitration or potential arbitration issues
  • Participation in management level meetings for the purpose of representation and integration of new and terminating products, systems, groups, into and out of Revenue Recovery production plans
  • Attend Court hearings, provide depositions, etc. for TPL and stop loss recoveries
  • Maintain IT requirements and needs on all systems for staff
  • Maintain regulatory compliance across the RR depts to include HIPAA, TPL:  Made Whole Rule, SB1471, Common Law doctrine, etc.

Required Qualifications:

  • Bachelor’s Degree or equivalent business knowledge and experience in Managed Health Care
  • 5 years’ experience in management / supervisory experience
  • 5 years of managed care experience in the area of Finance, Business Analysis, Revenue Recovery, or Claims
  • Working knowledge of Financials, HMO’s, Hospital, Ancillary and Provider contract language (DOFR’s, provider rates and stop loss agreements, etc.), shared risk settlements
  • Experience in medical claims or health plan contracting may be substituted for active claims examining/processing
  • High level of understanding in Finance, Contracting and Claims
  • Fluent experience in Excel
  • Access experience needed, SQL knowledge
  • Must be very multi-task oriented
  • Ability to oversee and delegate multi job tasks across support staff
  • High level of organization and development skills
  • Ability to handle challenging, time sensitive, sometimes stressful job responsibilities

To apply, please visit https://careers.unitedhealthgroup.com/ and search on job # 663233.

 

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)

North American Medical Management, California, Inc (NAMM California) partnered with OptumHealth in 2012. NAMM California and OptumHealth share a common goal of bringing patients, physicians, hospitals and payers closer together in the mission to increase the quality, efficiency and affordability of care. NAMM California is a part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system. NAMM California develops and manages provider networks, offering a full range of services to assist physicians and other providers in supporting patient care coordination and their managed care business operations. For over 18 years, NAMM California has been an innovator in health care with a track record for quality, financial stability, extraordinary services and integrated medical management programs. NAMM California is well positioned to continually invest in its infrastructure and systems for the benefit of its provider clients and to accommodate the impending changes that will come forth from healthcare reform.

The NAMM California provider clients represent a network of almost 600 primary care physicians and over 3,000 specialists and work with the premier hospitals in their respective markets.

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.