Provider Installation Administrator - West Valley City, UT - Full-time / Part-time

Expanding access to affordable, high quality health care starts here. This is where some of the most innovative ideas in health care are created every day. This is where bold people with big ideas are writing the next chapter in health care. This is the place to do your life's best work.(sm)
 
The Provider Installation Administrator is responsible for the installation and administration of assigned contracts, including, but not limited to: structure and billing set up, eligibility collection, database loading, and preparation of plan materials such as administrative documents and provider education materials. Provider Installation Administrators are also responsible for overall provider contract and amendment loading and processing using various databases. Responsibilities may also include auditing contract loads for adherence to quality measurers and reporting standards.
 
Primary Responsibilities:


Review provider contracts in order to ensure information submitted is accurate and consistent with loading guidelines

Communicate identified discrepancies back to contract submitter in order to facilitate corrections of discrepancies

Interpret and/or verify contract language, information, and intent in order to load information into systems properly

Perform audits of new and/or existing provider contracts and fee schedules in order to ensure accuracy

Research potential and/or existing providers by reviewing market rules, existing contracts, and/or provider specialty

Load contract information or implement updates and amendments (e.g., fee schedule updates, new fee schedules, demographic changes, termination, rate corrections) accurately into appropriate systems (e.g., NDB, COSMOS, FACETS, PPO-One, NICE,PULSE)

Review and/or maintain reports (e.g., metrics, dashboards, spreadsheets) associated with provider contract loading (e.g.,turnaround time, number of contracts loaded, accuracy) in order to assess performance, determine potential issues, and/or prioritize workloads (e.g., submissions to be addressed first)

Receive and respond to escalated issues and problems involving contract submissions

Interpret existing contracts in order to identify potential problems or issues needing correction

Receive and/or make determination regarding provider and/or contract changes or amendments (e.g., termination, product ads, revenue code changes, level of care

Collaborate with relevant internal and/or external partners (e.g., IT, CMS, Ingenix, vendors) to ensure that data is timely and accurate
 
 

Required Qualifications:


Undergraduate degree or equivalent experience

4+ years of experience in medical billing, claims processing, or contract installation including experience with facility/ancillary contract reimbursement methodologies

2+ years of experience with claims processing systems such as COSMOS, UNET etc.

Demonstrated understanding of relevant platforms (e.g., FACETS, NMDB, NDB, Emptoris, Diamond, PPO-One, NICE,PULSE)

2+ years of experience with medical coding (HCPCs, CPT-4, Revenue, DRG, ICD-9, etc.)

Ability to manage multiple projects concurrently, while maintaining a high level of quality and commitment to project timeframes

Ability to multi-task, shifting back and forth effectively between two or more activities or sources of information

Intermediate level of proficiency in Microsoft programs including Excel, Word and Access
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.(sm)


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.


Keywords: provider Installation, contract installation, claims processing, COSMOS, UNET, FACETS, NMDB, NDB, NICE, PULSE, West Valley City, UT, Utah
 
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