The Provider Reimbursement Specialist is responsible for developing programs, policies and strategies to ensure that contracted rates and reimbursement policies are applied accurately for company affiliates. Provider Reimbursement Specialists will analyze claims, pre and post payment, to ensure contracts and reimbursement policies and procedures are priced accurately; review claim disputes to verify correct pricing and analyze claim inquiry data to determine root cause of errors; recommend system changes, training and process improvements to prevent ...
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What makes your career greater with UnitedHealth Group? Growth opportunities among the variety of product lines and making an impact on the healthcare system ensures it will always be challenging and exciting.
AmeriChoice is searching for a Manager of Network Contracting, responsible for developing the physician network yielding a geographically competitive, broad access, stable network that achieves objectives for unit cost performance and trend...
UnitedHealthcare is part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system.When you work with UnitedHealthcare, what you do matters. It's that simple... and it's that challenging.In providing consumer-oriented health benefit plans to millions of people, our goal is to create higher quality care, lower costs and greater access to health care. Join us and you will be empowered to achieve new levels of excellence and make a profound and personal impact as you con...
Focus is on driving auditor quality to achieve monthly metrics. Responsible for identifying trends through root cause analysis on areas for improvement while providing quality feedback to the audit staff. Quality Analyst will ensure data integrity while validating provider contract, CMS and/or reimbursement policies are applied accurately. Must be able to formulate fact-based decisions on complex issues, and work independently utilizing knowledge previously acquired to unique situations. Use metrics, excellent time management skills and leadership skills to ensure business objectives and goals...
Positions in this function perform comprehensive research and identify billing abnormalities, questionable billing practices, and/or irregularities. Investigates, researches, and analyzes claims data applying knowledge of medical or pharmacy policy to determine details of fraudulent or abusive billing activity. Conducts internal audits of provider records, clinical records, and itemized bills so as to ensure appropriateness of billing practices and application of medical policy. Identifies and documents fraudulent or erroneous activity during an audit. Determines actual overpayment that may ha...
Position Description:What makes your career greater with UnitedHealth Group? Growth opportunities among the variety of product lines and making an impact on the healthcare system ensures it will always be challenging and interesting. The Senior Credentialing Representative is responsible for activities associated with credentialing or re-credentialing physicians and providers, including processing provider applications and re-applications including initial mailing, review, and loading into the database tracking system ensuring high quality standards are maintained. Senior Representatives will ...
The Network Contract Manager develops the provider network (physicians, hospitals, pharmacies, ancillary groups and facilities, etc.) yielding a geographically competitive, broad access, stable network that achieves objectives for unit cost perf...
Position Descriptions:
The Associate Provider Installation Specialist is responsible for the installation and administration of assigned contracts, including, but not limited to: structure and billing set up, eligibility collection, database loading, and preparation of plan materials such as administrative documents and provider education materials. Associate Provider Installation Specialists are also responsible for overall provider contract and amendment loading and processing using various datab...
Growth opportunities among the variety of product lines and making an impact on the healthcare system ensures it will always be challenging and exciting. The Appeals & Grievances Analyst is responsible for performing comprehensive research and identifying billing abnormalities, questionable billing practices, and/or irregularities. Appeals & Grievances Analysts will investigate, research, and analyze claims data, applying knowledge of medical or pharmacy policy to determine details of fraudulent or abusive billing activity. - Assess and interpret customer needs and requirements.- ...
In this exciting and challenging role, the Analyst will analyze and review payment structures for accuracy. To determine the payment accuracy they will use medical reimbursement policies, provider contracts and how the contract has been loaded to reimburse systematically. In this role the analyst would be reviewing multiple processing systems as well as utilizing supporting databases to determine payment accuracy. Primary role would be to aide in the recovery of overpayments and to remove any barrier ...
Network Contract Manager - Oregon(323167)Full-time with UnitedHealth Networks in Lake Oswego, OregonPosted 3/23/2010
Healthcare Contract Specialist - Prescription Solutions, Cypress, CA(324102)Full-time with Prescription Solutions in Cypress, CaliforniaPosted 3/31/2010
Provider Relations Advocate - Hockessin, DE(324106)Full-time with AmeriChoice in Dover, DelawarePosted 3/31/2010
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