Reimbursement Specialist – Remote Nationwide

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. 

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

Primary Responsibilities:

• Ensure accurate Government reimbursement calculations, to include, but not limited to CMS DRG, facility specific factors and IME/Disproportionate Share, Tricare/VA, Medicaid APR DRG and OP reimbursement, rural health supplemental/differential reimbursement, as well as other government payment methodologies that have reimbursement implications
• Perform zero balance reviews of underpaid accounts to reduce outside vendor spend
• Auditing and updating Managed Care contracts including the maintenance and update of CPT/ASC/APC/RVU/CMG /IRF/DRG tables
• Reviewing payment variance to identify trends and root causes. Track and trend issues to resolution.  Inform Management of all identified trends and issues
• Collaborate with various departments to address and resolve internal trends
• Escalate payer-related trends to Payer Solutions team and attend JOC (Join Operating Committee) with payers to resolve denial trends and/or payer-related issues to improve cash collection and reduce AR
• Triage questions from other departments regarding payer calculations
• Extensive Acute and Ambulatory claim review of expected versus actual payment variances to ensure accuracy and maximize reimbursement
• Stay up-to-date with federal, state, and payer-specific reimbursement policies and regulations
• Prepare and submit appeals/disputes for underpaid/denied claims
• Perform reviews, research and other duties independently or as requested by the Optum Leadership and Clients

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)
• 3+ years of experience with hospital reimbursement methodologies, direct hospital managed care analysis or hospital collections experience
• 3+ years of experience in billing including CPT, ICD-10, HCPCS coding and EOB interpretation
• 3+ years of experience analyzing complex financial data and reimbursement trends
• 3+ years of experience in healthcare reimbursement regulations and payer policies
• Intermediate level of proficiency with Microsoft Office (Outlook, Excel, Word, PowerPoint, Visio, One Note, SharePoint)
• Valid US driver’s license

Preferred Qualifications:

• Undergraduate degree
• Experience with automated Expected Reimbursement or Contract Management software systems
• Knowledge of legal and regulatory requirements associated with fee-for-service and managed care risk contracting for professional services to commercial, Medicaid and Medicare Advantage populations
• Knowledge to design compensation methodologies, calculate and evaluate compensation rates, and project the effect on revenues and expenses

Soft Skills: 

• High attention to detail to ensure accuracy in claims, payments, and reporting
• Ability to manage multiple tasks and priorities in a fast-paced environment
• Ability to organize and prioritize activities with specific attention to details and higher-level strategies, including effective time management skills
• Excellent verbal and written communication skills for interacting with internal teams and external payers
• Skilled in identifying problems, determining root causes, and implementing effective solutions

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

    

The salary range for this role is $28.61 to $56.06 per hour based on full-time employment. 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. 

    

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.

    

    

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

   

UnitedHealth Group is a drug – free workplace. Candidates are required to pass a drug test before beginning employment.

    

    

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