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Provider Reimbursement Representative - Ontario, CA (738188)

Position Description

Energize your career with one of Healthcare’s fastest growing companies.  
You dream of a great career with a great company - where you can make an impact and help people. We dream of giving you the opportunity to do just this. And with the incredible growth of our business, it’s a dream that definitely can come true. Already one of the world’s leading Healthcare companies, UnitedHealth Group is restlessly pursuing new ways to operate our service centers, improve our service levels and help people lead healthier lives. We live for the opportunity to make a difference and right now, we are living it up.
This opportunity is with one of our most exciting business areas: Optum - a growing part of our family of companies that make UnitedHealth Group a Fortune 17 leader.
Optum helps nearly 60 million Americans live their lives to the fullest by educating them about their symptoms, conditions and treatments; helping them to navigate the system, finance their healthcare needs and stay on track with their health goals. No other business touches so many lives in such a positive way. And we do it all with every action focused on our shared values of Integrity, Compassion, Relationships, Innovation & Performance.
As a Provider Reimbursement Representative, you will conduct ongoing evaluation, analysis, and organization of all cap related procedures to accurately calculate monthly PCP and specialty provider capitation payments according to contractual terms.
Primary Responsibilities: 
  • Comprehends Provider contracts, is able to determine capitation terms and effectively incorporate changes and / or updates for configuration. Appropriately tests all changes for accuracy and implements into the cap process
  • Identify and configure necessary additions, changes and deletions to new and existing configuration design as it relates to capitation
  • Originates scheduling of pre-cap/ post-cap calculations and capitation reports. Coordinates report extractions with Business Analyst and team members. Identifies variances and issues, analyzes and implements data for review, communicates issues and receives approvals from Executive Directors
  • Ensures accuracy of data on Excel spreadsheets by verifying proper linking. Audits raw data, compares with worksheets to verify proper PCP / Specialty cap calculations. Generates and submits PCP / Specialty cap payment upload requests to Accounts Payable for processing
  • Works with Lead, Business Analysts and Manager, in troubleshooting system and reporting or process issues. Must be able to effectively analyze issues and communicate problem-solving ideas
  • Reconciles PCP / Specialty cap expense to general ledger. Generates cap related reports to perform PCP / Specialty audits, adjustments, check requests, analyses, research and special projects, as required
  • Collaborates with the IS staff in developing and testing of system upgrades
  • Utilizes various computer programs to research provider, member and eligibility information. (Claims System / Claims System test, Crystal, Excel, Word, Access, Great Plains)
Required Qualifications: 
  • High School Diploma / GED
  • 3+ years of demonstrated success in analysis and problem solving in finance-related positions with increasing levels of responsibility
  • General knowledge in managed care industry and insurance billing / collections
  • Working knowledge of Microsoft Excel, Microsoft Word, and Microsoft Outlook
Preferred Qualifications: 
  • Microsoft Access experience
  • 2+ years of college with an emphasis in Business, Finance or Accounting
  • Understanding of transaction systems and data flow
  • A basic knowledge of ICD-10 and CPT coding
Soft Skills:
  • Must be able to effectively communicate both verbally and in writing with all levels of management and to prioritize goals and responsibilities in a proactive manner
  • Self-motivated with excellent organization, analytical and follow-up skills, accuracy, flexibility and attention to detail
  • Ability to work independently and to participate as a team member
  • Capability to pool resources and set and obtain goals in a team environment while demonstrating good judgment, attitude and professionalism
Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system 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.
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.

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.
Job Keywords: Provider Reimbursement, analyst, eligibility, capitation, Ontario, CA, California

Job Details

  • Contest Number738188
  • Job TitleProvider Reimbursement Representative - Ontario, CA
  • Job FamilyNetwork Management
  • Business SegmentOptumCare

Job Location Information

  • Ontario, CA
    United States
    North America

Additional Job Detail Information

  • Employee StatusRegular
  • ScheduleFull-time
  • Job LevelIndividual Contributor
  • ShiftDay Job
  • TravelNo
  • Telecommuter PositionNo
  • Overtime StatusNon-exempt