Recovery/Resolution Manager - 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. Primary Responsibilities: Site management, implementation and day-to-day performance of process activities related to Hospital Bill Audits access and appeals issues Serve as manager of state assignment facilities audit process, coordinating and managing all resources needed to fulfill the requirements of the core processes of audits Review 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 Analyze data to identify root cause of dispute Appropriately document findings and forward to appropriate internal division for resolution Validate all root cause of documentation prepared by Medical Cost Recovery Analysts Ensure that documentation for all requested claims adjustments are consistent with Medical Claim Recovery Documentation Requirements 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 RecoveryQualifications: Analyze data to identify trends and issues Make decisions and work independently Excellent written and verbal communication skills Manage multiple priorities. Problem solving 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 health plan experience in claims, contracting or auditing Extensive knowledge of medical coding, industry forms, P&Ps and reimbursement issues Extensive knowledge of COSMOS or UNET, as well as desk top applications Working knowledge of key linkages, such as reimbursement, finance and contracting Previous managerial experience preferred RN/LPN Diversity creates a healthier atmosphere:  equal opportunity employer M/F/D/V. UnitedHealth Group is a drug-free workplace.  Candidates are required to pass a drug test before beginning employment.