Provider Reimbursement Specialist – National Remote

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together. 

 

Here’s an opportunity to vet your skills and vision as a manager and innovator. Take on this leadership role with UnitedHealth Group and you’ll be part of a team that’s reshaping how health care works for millions by building and maintaining effective, accessible provider networks. You’ll help hire, train, develop and lead a team of Provider Contract Installation staff. The team mission is to ensure accurate loading, which includes setting up plan structure and billing, eligibility collection and database loading. You’ll discover the impact you want and the resources, backing and opportunities that you’d expect from a Fortune 6 leader. Get ready for a high impact role. This position is challenging because it’s a production environment that is extremely fast paced. You’ll be working with multiple teams updating demographics and making updates in the network database system.

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

Primary Responsibilities:

• Research and develop applicable business rules that support product reimbursement methodologies and policies for existing and new business opportunities
• Develop and submit fee schedules and/or provider rates to claim pricing platforms
• Perform post-load quality analysis review on relevant claim platform submissions and provide correction instructions if necessary
• Write technical specifications or business requirements that support the development of business applications or existing system enhancements
• Perform and/or review user acceptance testing of relevant applications (e.g., support fee schedule; rate submissions; fee builder tool; claim editing system; claim pricing system)
• Write internal operational and/or reimbursement policies that support global functions
• Work with business partners to develop and/or create provider agreements and payment appendices to reflect terms of the provider reimbursement strategies
• Research new opportunities to improve operating efficiencies, implement medical cost savings and/or reduce administrative expenses, and provide appropriate recommendations to applicable audiences
• Review State websites for the markets assigned on a weekly basis to research any Fee Schedule changes and submit on Auto load to PCRL to ensure most appropriate pricing is documented and loaded in our systems

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)
• 1+ years of experience supporting fee schedule load
• 1+ years or experience working on CSP FACETs
• 1+ years of experience with provider contract and/or interpretation of the State requirements but not limited to RFPs and contracts
• Intermediate level of proficiency in Microsoft programs including Excel and Word

Preferred Qualifications:

• Experience in medical billing, claims processing or contract installation including experience with facility or ancillary contract reimbursement methodologies
• Claims processing or resolution experience
• Experience managing multiple projects concurrently, while maintaining a high level of quality and commitment to project timeframes
• Experience training others on core job functions
• Experience in a role exposing you to provider contract
• Undergraduate degree or equivalent 

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

 

California, Colorado, Nevada, Connecticut, New York, New Jersey, Rhode Island, Hawaii, Washington or Washington, D.C. Residents Only: The hourly range for California, Colorado, Nevada, Connecticut, New York, New Jersey, Rhode Island, Hawaii, Washington or Washington, D.C. residents is $28.03 to $54.95 per hour. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. 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. 

 

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records. 

 

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. 

 

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location, and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.

 

 

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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