Provider Reimbursement Specialist - 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.

Here's an opportunity to vet your skills and vision as a manager and innovator. Take on this leadership role with UnitedHealth Group and you'll be part of a team that's reshaping how health care works for millions by building and maintaining effective, accessible provider networks. You'll help hire, train, develop and lead a team of Provider Contract Installation staff. The team mission is to ensure accurate loading, which includes setting up plan structure and billing, eligibility collection and database loading. You'll discover the impact you want and the resources, backing and opportunities that you'd expect from a Fortune 6 leader. Get ready for a high impact role. This position is challenging because it's a production environment that is extremely fast paced. You'll be working with multiple teams updating demographics and making updates in the network database system.

You'll enjoy the flexibility to telecommute* as you take on some tough challenges.

Primary Responsibilities:

• Develops and executes strategies for a function or discipline that span a large business unit or multiple markets/sites
• Research and develop applicable business rules that support product reimbursement methodologies and policies for existing and new business opportunities (e.g., Medicare; Medicaid; commercial)
• Support ongoing maintenance of pay as state pay facility pricing and all unique regulatory pricing requirements to specific Medicaid markets for C&S and other payor contracts
• Write technical specifications or business requirements that support the development of business applications or existing system enhancements
• Research new opportunities to improve operating efficiencies, implement medical cost savings and/or reduce administrative expenses, and provide appropriate recommendations to applicable audiences (e.g., senior management, National Reimbursement Policy Forum)
• Measure work against established metrics and ensure effective processes
• Establish and communicate team priorities
• Identify and resolve operational and workflow problems
• Identify and implement process improvements to ensure effective and efficient processing of work
• Lead projects as necessary or assigned

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 experience in medical billing, claims processing or contract installation
• 1+ years of experience with claims processing systems such as COSMOS or UNET; or 1+ years of experience working with NDB
• 1+ years of experience in a role exposing you to provider contracts
• Intermediate level of proficiency in Microsoft programs including Excel and Word

Preferred Qualifications:

• Medical coding (HCPCs, CPT-4, Revenue, DRG, ICD-9, etc.)
• Claims processing or resolution experience
• Experience managing multiple projects concurrently, while maintaining a high level of quality and commitment to project timeframes
• Experience training others on core job functions

*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.

California, Colorado, Nevada, Connecticut, New York, New Jersey, Rhode Island, Hawaii or Washington Residents Only: The hourly range for California, Colorado, Nevada, Connecticut, New York, New Jersey, Rhode Island or Washington residents is $28.03 to $54.95 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.

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.

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