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.Provider Reimbursement Specialist develops programs, policies and strategies to ensure that contracted rates and reimbursement policies are applied accurately for company affiliates. Analyzes claims, pre and post payment, to ensure contracts and reimbursement policies and procedures are priced accurately. Reviews claim disputes to verify correct pricing and analyzes claim inquiry data to determine root cause of errors; recommends system changes, training and process improvements to prevent future errors. Works with both internal and external customers to identify and resolve complex problems. Assists company affiliates with initial deployment and ongoing support of systems and processes to leverage national network rates and policies. Fee schedule and contract template maintenance is also included in this function.If you are looking for a challenge, this fast-paced, performance driven team environment is the place to be. You'll be expected to provide analytical expertise and accurate direction on pricing while meeting aggressive production goals.You’ll enjoy the flexibility to telecommute from anywhere within the U.S. as you take on some tough challenges.Primary Responsibilities:
Implement programs designed to ensure proper application of contracted rates and reimbursement policies for company affiliates
Perform analysis of claims, pre and post payment, to ensure proper pricing of contracts, reimbursement policies and procedures
Review claim disputes to verify correct pricing and analyze claim inquiry data to determine root cause of errors and recommend system changes, training and process improvements to prevent future errors
Identify and solve a range of problems within area of expertise
Investigate non-standard requests and problems
Analyzes and investigates
Provides explanations and interpretations within area of expertise
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 inRequired Qualifications:
High School Diploma/GED (or higher)
3+ years of experience with claim processing in the CSP claims platform
3+ years of experience reviewing contracts and ensuring CSP claim system is loaded per the contract
3+ years of experience completing claim adjustments
1+ years of experience managing a project end-to-end
1+ years of experience resolving the root cause, not just get a claim paid
1+ years of experience with Medicare regulations, ability to research Medicare regulations and drive updates to claim processing instructions that need to be aligned with Medicare
Ability to facilitate meetings with leadership and subject matter experts to drive resolution of root cause
Ability to operate in a demanding environment and collaborate with team members and internal business partners to serve our customers successfully
Preferred Qualifications:
Intermediate knowledge of Excel to be successful with data manipulation when resolving root cause and scoping out projects
3 years + of experience with claim processing in the Cosmos claims platform
Bachelor’s degree
Soft Skills:
Desire to learn, technologically savvy, and willing to learn various systems to interact with internal business partners
Clear and professional communication is expected when corresponding directly with customers and internal business partners
All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.California, Colorado, Nevada, Connecticut, New York, New Jersey, Rhode Island, Hawaii, Maryland, Washington, or Washington D.C Residents Only : The salary range for California, Colorado, Nevada, Connecticut, New York, New Jersey, Rhode Island, Hawaii, Maryland, Washington, or Washington D.C residents is $70,200 to $137,800 per year. 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.#RPO #GREEN