Manager of Submissions - Risk Adjustment - San Antonio, Texas San Antonio, TX

    UnitedHealth Group Inc.
    San Antonio, TX 78201
    Full-time
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    Job Description

    Our customer service & claims teams are helping people from around the world. We can bring out your best as you put your listening, analytical and problem solving skills to work in a setting that is geared to helping improve lives and enhance health care for millions. Here, you'll discover a wealth of pathways for professional growth within Customer Service and across our global economy. Join us and find out why this the place to do your life's best work.SM

    Tough challenges? We know a thing or two about those. When you're on a mission to help people live healthier lives, the stakes couldn't be higher. As a Business Analyst Consultant, you will help rewrite the future of the health care system. You'll analyze data and deliver bold, business-savvy ideas to impact the lives of millions. Along with ground-breaking challenge, you'll have the support and resources of a Fortune 6 company. Join us.

    The Manager of Submissions, Risk Adjustment, supervises, directs, plans, and organizes the processes that drive the collection, submission, deletion and reporting of data required by the Centers for Medicare and Medicaid Services (CMS). This position is responsible to maintain and improve the submission acceptance rate. Secondarily the manager will be responsible to consult on the development, specification and integration of WellMed's Risk Adjustment Submissions and Reconciliation systems. This position will oversee day-to-day operations of WellMed's Risk Adjustment Submissions and Reconciliation processes.

    Primary Responsibilities:
    • Develops policies and procedures for system, application and related operational processes in order to ensure submission record optimization and compliance with established standards and regulations internally at WellMed and externally with CMS or other regulating body
    • Ensures that the risk adjustment diagnostic submissions to CMS and/or health plans or their intermediary occur timely and accurately; this includes additions and deletions where appropriate
    • Provides claims/encounter data reconciliation between CMS and/or health plans or intermediary with business claims and coding detail to ensure accurate risk adjustment payments on behalf of provider groups
    • Provides short range trouble shooting for day-to-day issues and ongoing maintenance with Risk Adjustment Submissions and Reconciliation applications and reporting. Makes recommendations as needed to ensure reliability of the systems and finds innovative solutions if problems should occur
    • Ability to lead a team with a positive leadership style that drives high employee engagement and performance
    • Perform all supervisory duties such as assigns work, provides direction, validates quality of work and functional directs team members in order to achieve operational objectives
    • Develops and maintains positive relationships with both internal/externals customers at the senior management and executive level. Must have the ability to review, analyze and interpret
    • Demonstrated ability to conceptualize an initiative, develops and maintain a plans, and execute to plan
    • Ability to collaborates and or oversee cross-functional teams for initiatives
    • Demonstrated ability to problem solve and review and interpret data with the intention to determine options and make recommendations
    • Performs all other related duties as 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:
    • Bachelor's degree in Finance, Business, Computer Science, Information Systems or related technical field (4+ years of comparable work experience beyond the required years of experience may be substituted in lieu of a bachelor's degree)
    • 5+ years in healthcare and/or medical claims experience and/or performing system analysis
    • 1+ year's supervisory experience
    • Experience with various system development lifecycles such as waterfall, and Agile methods
    • Ability to effectively work with both internal and external clients and all levels of leadership
    • Excellent interpersonal skills, high energy and enthusiasm, with the ability to thrive in a collaborative, high performance and action oriented team environment
    • You will be asked to perform this role in an office setting or other company location
    Preferred Qualifications:
    • Working knowledge of Medicare Risk Adjustment and/or Medical Claims processing
    • Advanced degree in a related discipline
    • 2+ years of experience in Health Care
    • 3+ year's supervisory experience
    • 5+ years of experience in one or more of the following areas: systems design, database programming experience, HL7 integration, X12 integration, EDI, practice management system implementation and support, EMR system implementation and support, Claim adjudication system implementation and support, Care Management system implementation and support
    Physical & Mental Requirements:
    • Ability to lift up to 25 pounds
    • Ability to push or pull heavy objects
    • Ability to sit for extended periods of time
    • Ability to stand for extended periods of time
    • Ability to use fine motor skills to operate office equipment and/or machinery
    • Ability to properly drive and operate a company vehicle
    • Ability to receive and comprehend instructions verbally and/or in writing
    • Ability to use logical reasoning for simple and complex problem solving
    Careers with WellMed. Our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors. We're impacting 240,000+ lives, primarily Medicare eligible seniors in Texas and Florida, through primary and multi-specialty clinics, and contracted medical management services. We've joined Optum, part of the UnitedHealth Group family of companies, and our mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness. Our providers and staff are selected for their dedication and focus on preventative, proactive care. For you, that means one incredible team and a singular opportunity to do your life's best work.SM

    OptumCare is committed to creating an environment where physicians focus on what they do best: care for their patients. To do so, OptumCare provides administrative and business support services to both owned and affiliated medical practices which are part of OptumCare. Each medical practice part and their physician employees have complete authority with regards to all medical decision-making and patient care. OptumCare's support services do not interfere with or control the practice of medicine by the medical practices or any of their physicians.

    WellMed was founded in 1990 with a vision of being a physician-led company that could change the face of healthcare delivery for seniors. Through the WellMed Care Model, we specialize in helping our patients stay healthy by providing the care they need from doctors who care about them. We partner with multiple Medicare Advantage health plans in Texas and Florida and look forward to continuing growth.

     

    Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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.

    OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment

    Job Keywords: Manager, Submissions, San Antonio, Texas, TX

    Posting ID: 588102614Posted: 2020-11-19