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Use left and right arrow keys to navigate
Hours Full-time, Part-time
Location Eden Prairie, MN
Eden Prairie, Minnesota

About this job



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)
Professional Network Management, Fee Schedule Operations, UnitedHealthcare Community & State (PNM-FSO UHCS), supports the fee schedule build, configuration, and maintenance of all C & S Medicaid, Medicare, and other state products, like MLTSS (Managed long-term services) and HCBS (Home and Community Based Services) for professional and ancillary providers.  We ensure that fee schedules owned by PNM are updated in accordance with the terms of our contracts and any state or federal regulatory requirements.
 
PNM-FSO UHCS's vision is to always provide the forces needed to deliver quality service and care to our Community and State business partners, providers and members by also keeping an open mind to new and better ways to manage all of our processes. We will continue to focus on process improvement and quality of service.
 
The Provider Reimbursement Specialist is responsible for developing programs, policies and strategies to ensure that contracted rates and reimbursement policies are applied accurately for company affiliates.  This specific position may also provide coaching, training and general team support. 
 
Provider Reimbursement Specialist responsibilities also include fee schedule and contract template maintenance.  They will also analyze claims, pre- and post-payment, to ensure contracts and reimbursement policies and procedures are priced accurately; review claim disputes to verify correct pricing and analyze claim inquiry data to determine root cause of errors; recommend system changes, training and process improvements to prevent future errors; work with both internal and external customers to identify and resolve complex problems; assist company affiliates with initial deployment and ongoing support of systems and processes to leverage national network rates and policies.
 
Primary Responsibilities:

Assess and interpret customer needs and requirements
Identify solutions to non - standard requests and problems
Solve moderately complex problems and / or conducts moderately complex analyses
Work with minimal guidance; seek guidance on only the most moderately to complex   tasks
Translate concepts into practice
Provide explanations and information to others on difficult issues
Act as a resource for others with less experience

Requirements

Required Qualifications:

2+ years’ experience in claims, contracting, reimbursement, or other affiliated services related to Medicaid and Medicare services
2+ years’ experience in physician reimbursement, policy payment, and/or coding methodologies, including CMS (Centers for Medicare & Medicaid Services)
Exceptional organizational skills and negotiation skills
Excellent verbal and written communication skills with the ability to clearly articulate information in a clear and concise manner
Ability to effectively multi task, effectively managing multiple projects and initiatives
Intermediate proficiency in MS Excel, Word & PowerPoint; at least beginner proficiency in Access
Preferred Qualifications:

Undergraduate degree
Claims platform experience, such as CSP Facets or Cosmos
Experience with clinical editing tools in support of physician reimbursement policy
Experience in project management
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.
 
 
Job Keywords: Physician Reimbursement, Medicaid Reimbursement, Stat Programs, Claims Reimbursement, Contracting, Claims Analyst