Senior Provider Reimbursement Representative - Columbia, MD

Position Description:

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 Senior Provider Reimbursement Representative is responsible for activities associated with developing programs, policies and strategies to ensure that contracted rates and reimbursement policies are applied accurately for company affiliates. Senior Provider Reimbursement Representatives support those who 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. Other responsibilities may include involvement with fee schedule and contract template maintenance.

Primary Responsibilities:

• Apply basic knowledge of theories, practices and procedures in a function or skill.
• Perform routine or structured work.
• Respond to routine or standard requests.
• Use existing procedures and facts to solve routine problems or conduct routine analyses.
• Depend on others for instruction, guidance or direction.
• Position will be located in the Columbia MD office, as part of Spectera.
• Resource will research reimbursement issues, find root cause, and answer questions on processing from multiple perspectives. Currently the research is being completed by other associates within Provider who are not able to perform their primary function due to the volume of reimbursement or data setup issues that are interrupting their run the business work. Between the time allocated by the QA and network research resources, over 160 hours per week are being spent on working reimbursement questions that are stuck at various points and identifying how to resolve the issues. Once root cause has been established the scope will be expanded to determine if similar situations exist and the data will be forwarded to the correct department to address.
• Adding this role as an FTE will allow a current contractor position to be eliminated.
• 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.

Required Qualifications:

• High School Diploma/GED.
• 4+ years experience in Healthcare Customer Service.
• 2+ years experience with Claim Processing.
  

Careers at UnitedHealthcare Employer & Individual. We all want to make a difference with the work we do. Sometimes we're presented with an opportunity to make a difference on a scale we couldn't imagine. Here, you get that opportunity every day. As a member of one of our elite teams, you'll provide the ideas and solutions that help nearly 25 million customers live healthier lives. You'll help write the next chapter in the history of health care. And you'll find a wealth of open doors and career paths that will take you as far as you want to go. Go further. This is your life's best work.SM

 

Diversity creates a healthier atmosphere: 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.