Provider Reimbursement Specialist – Remote in WA or NC

At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together.   

If you reside in Washington or North Carolina, you will have the flexibility to work remotely* as you take on some tough challenges.

Primary Responsibilities:

• AR Case management. Validation and review of analyst findings and remediate underlying issues
• Analyze and develop overall improvement plans to ensure passing of audits, performance guarantees, and overall market noise / provider abrasion
• Identify trending errors; perform root cause analysis to remediate large scope payment discrepancies
• Communicate trends to internal business partners and providers/customers
• Collaborating with leadership by contributing to the development of improvement plans
• Retain self-proficiency (e.g. maintain / increase skills) of competencies related to their primary LOB. (Cosmos/UNET/CSP Facets)
• Manage relationships with Account Management teams to ensure coordination of work – plans and root cause remediation activities
• Present client specific issues and project status to senior level audience
• Escalate issues as appropriate to varying audiences including regular meetings
• Meet with internal and external teams on program results and support 1:1 readiness for account onboarding
• Support team members with questions and guidance, act as a SME for your primary LOB (if applicable)
• Facilitate meetings both internal and external at multiple levels of the organization(s)
• Create executive summaries to communicate updates and education on accounts receivable results
• Pivot and restructure data to provide education on complex issues in a simplified manner
• Remediate provider / UHC disagreements in a professional manner; take continuous feedback to promote improved relationships and higher understanding of the cause of any discrepancies
• Design and create visual tracking tools to compile and communicate progress
• Contribute to team metrics goals and meet internal TAT goals
• Review first level quality rebuttals (if applicable)
• Use Provider Operations data and analysis from our daily audits to outline trends and resolution needs including provider education

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:

• 3+ years of experience in claims research, analysis, and excel
• 3+ years of experience working with reimbursement methodologies
• 2+ years of experience working within your primary LOB (Cosmos / UNET/CSP Facets.)
• 6+ months of experience creating and conducting effective presentations
• Intermediate level of proficiency with MS Office (Excel, Word and PowerPoint)
• Resident of WA or NC
• Willing and able to travel up to 25% within a state of hire

Preferred Qualifications:

• Experience with Smart sheets
• Comfortable facilitating meetings

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you’ll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $28.27 to $50.48 per hour based on full-time employment. We comply with all minimum wage laws as applicable.                    

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.

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.