Associate Regulatory Adherence Analyst – 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. 

The Regulatory Affairs Associate will manage a portfolio of Medicaid and Medicare provider enrollments for Optum owned pharmacies. 

You will be part of the OptumRx Government Programs Licensing team, a team of highly skilled and experienced licensing specialists that help support our pharmacies. In this role, you will monitor, analyze and handle requests from the Centers for Medicare and Medicaid Services (CMS) regarding pharmacy provider enrollments. This includes, but is not limited to, completion of new applications, revalidations, changes of information, license updates, relocations, banking information updates, voluntary relinquishments and other related inquiries. You will ensure the timely submission of materials to state Medicaid agencies via online portals and to Medicare via the Provider Enrollment, Chain, and Ownership System (PECOS) to maintain enrollments. You will have considerable contact with state Medicaid agencies and Medicare Administrative Contractors (MACs). You will learn to utilize licensing tools, maintaining electronic files and update customized databases. You will review incoming email inquiries and handle timely and accordingly. You will assist in resolving licensing issues as needed and communicate with the leadership on complex issues and offer suggestions for process improvements and recommendations. Come join a solid team, build partnerships, work collaboratively to meet shared objectives and learn the nuances of the Medicaid and Medicare business.

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

Primary Responsibilities:

• Access state Medicaid portals online and the PECOS system for Medicare enrollments
• Renewal and Application Submission – Support the needs of the business by preparing and submitting Medicaid and Medicare enrollment applications or revalidations timely and accurately
• Special Projects – Coordinate with Senior Specialist to support all special projects by updating existing enrollments accordingly
• License Tracking – Monitor and track licensing activities for assigned book of business
• Documentation Management – Maintain accurate records and documentation related to licenses and adhere to internal written procedures
• Assess and prioritize workload appropriately
• Problem Resolution – Troubleshoot complex claims/billing issues and remediation activities as needed
• Communication – Establish and maintain effective communication channels with relevant regulatory agencies and inform leadership on any licensing concerns or if metric dates will not be met
• Compliance Assurance – Conduct regular reviews of CMS bulletins and new regulations to ensure ongoing compliance with regulatory guidelines
• Follow up with regulatory agencies which includes calling state Medicaid agencies and Medicare MACs

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 direct CMS Medicaid AND/OR Medicare pharmacy provider enrollment experience 
• 1+ years of experience directly submitting and maintaining pharmacy enrollment applications
• 1+ years of proven experience with interacting and collaborating with a variety of stakeholders and in a team setting 
• Intermediate level of proficiency with regulatory requirements and processes
• Intermediate level of proficiency with Microsoft Word (creating and editing documents), Excel (general spreadsheet navigation, data entry/sorting data), Teams, PowerPoint and Outlook (scheduling meetings, email and calendar)

Preferred Qualifications:

• Currently located within Minnesota 
• Willingness and ability to work effectively during periods of change
• Ability to remain resilient in a changing highly regulatory environment
• Ability to work in a fast-paced, high-volume environment effectively

Soft Skills:

• Strong problem solving and analytical skills
• Strong verbal and written communication skills 
• Self-motivated contributor who takes ownership of tasks from start to finish
• Work effectively both as part of a team and independently
• Strong time management skills     

*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 $23.22 to $45.43 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. 

 

 

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