Recovery\/Resolution Consultant - Remote

Careers at UnitedHealth Group

We're creating opportunities in every corner of the health care marketplace to improve lives while we're building careers. At UnitedHealth Group, we support you with the latest tools, advanced training and the combined strength of high caliber co-workers who share your passion, your energy and your commitment to quality. Join us and start doing your life's best work. SM


Compassion. It's the starting point for health care providers like you and it's what drives us every day as we put our exceptional skills together with a real feeling of caring for others. This is a place where your impact goes beyond providing care one patient at a time. Because here, every day, you're also providing leadership and contributing in ways that can affect millions for years to come. Ready for a new path? Learn more, and start doing your life's best work. SM

Our teams are helping people from around the world. We can bring out your best as you put your listening, analytical and problem solving skills to work in a setting that is geared to helping improve lives and enhance health care for millions. Here, you'll discover a wealth of pathways for professional growth within Customer Service, Billing, Claims, Enrollment & Eligibility and across our global economy. Join us and find out why this is the place to do your life's best work. SM

You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Healthcare isn't just changing. It's growing more complex every day. ICD - 10 Coding replaces ICD - 9. Affordable Care adds new challenges and financial constraints. Where does it all lead? Hospitals and Healthcare organizations continue to adapt, and we are vital part of their evolution. And that's what fueled these exciting new opportunities.

Who are we? Optum360. We're 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 our compassion, our talent, our resources and experience to bring financial clarity and a full suite of Revenue Management services to Healthcare Providers, nationwide.

If you're looking for a better place to use your passion, your ideas and your desire to drive change, this is the place to be. It's an opportunity to do your life's best work. SM

The Recovery and Resolution Consultant is responsible for identifying internal and payer issues by analyzing AR greater than 90 days and conducting regular Joint Operating Committee Meetings (JOCs) to address payer issues. Will work with payer and internal Revenue Cycle teams to provide problem resolution. Communicates well, to explain research and findings to management and may be utilized as a training resource within the department or to external customers. Must have experience reading hospital contracts, account review experience, and analytical work experience to provide trends and claims issues. This position requires the ability to work well independently and also succeed in a team environment to hit deadlines as needed. The Recovery and Resolution Consultant also assists in the improvement of internal business processes and meeting future reimbursement service needs.

Training will be conducted virtually from your home. This position is full-time (40 hours/week) Monday to Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00am - 5:00pm. It may be necessary, given the business need, to work occasional overtime or weekends.

*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.

Primary Responsibilities:
  • Analyze claims data to identify trends / claims issues and provide reports to Management as necessary
  • Breakdown complex problems into individual root causes
  • Ensure that reimbursement procedures adhere to insurance regulations and payers' contractual obligations
  • Review claim payment accuracy, timeliness, and collection processes by ensuring issues are avoided, or if identified, resolved timely and appropriately
  • Conduct regular JOC (Joint Operating Committee) meetings with assigned payers to address and resolve identified payer issues in a timely manner
  • Prepare and coordinate presentations, trainings, etc; used as an educational resource
  • Create and maintain relationships with internal departments / payers to work to resolve reimbursement issues and make recommendations for improving processes
  • Serve as a Subject Matter Expert (SME) for Internal Departments, Vendors, Management and Clients on payer processes and policies
  • May involve some interfacing with clients, managed care customers, Payer resources, and others when needed
  • Manage progress of payer projects within Aha Project Management database
  • Lead various special projects as needed with little to no manager supervision or assistance

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:
  • High School Diploma / GED (or higher)
  • 5+ years of collections (in patient acute hospital) experience
  • 3+ years of analytics experience (able to review accounts to isolate trends, pull data and communicate trends effectively to senior level reporting)
  • 5+ years of experience in reading Hospital based contacts
  • Proficient with Microsoft Word (creating and editing documents), Microsoft Excel (pivot tables), and Microsoft Powerpoint (creating and editing slides)
  • Knowledge of state, federal and industry standard fee schedules, reimbursement methodologies and regulations, including but not limited to: DRG, ASC, APR-DRG, and OPPS
  • Ability to travel 5% or less of the time

Telecommuting Requirements:
  • Required to have a dedicated work area established that is separated from other living areas and provides information privacy
  • Ability to keep all company sensitive documents secure (if applicable)
  • Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service

Preferred Qualifications:
  • Associate's Degree (or higher)
  • 6+ years as a senior collector
  • 4+ years of analytic experience
  • 2+ years of experience running a Joint Operating Committee meeting
  • Ability to perform basic mathematical calculations, balance and reconcile figures

Soft Skills:
  • Strong written and oral communication skills
  • Strong analytical, problem solving and organizational skills
  • Must be able to work well independently and also succeed in a team environment
  • Demonstrated ability to handle multiple projects simultaneously and prioritize projects
  • Demonstrated ability to meet deadlines, multi - task, problem solve, use appropriate technology to analyze business problems and deliver accurate and precise results
  • Demonstrated ability to analyze complex claims transactions

UnitedHealth Group requires all new hires and employees to report their COVID-19 vaccination status.

Military & Veterans find your next mission: We know your background and experience is different and we like that. UnitedHealth Group values the skills, experience and dedication that serving in the military demands. In fact, many of the values defined in the service mirror what the UnitedHealth Group culture holds true: Integrity, Compassion, Relationships, Innovation and Performance. Whether you are looking to transition from active duty to a civilian career, or are an experienced veteran or spouse, we want to help guide your career journey. Learn more at

Learn how Teresa, a Senior Quality Analyst, works with military veterans and ensures they receive the best benefits and experience possible.

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

Colorado, Connecticut or Nevada Residents Only: The salary range for Colorado residents is $64,800 to $116,000. The salary range for Connecticut / Nevada residents is $71,400 to $127,400. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you'll find a far-reaching choice of benefits and incentives.

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.

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