Senior Provider Reimbursement Specialist - Remote

Senior Community Care Team Member

Optum Home & Community Care, part of the Optum family of businesses, is creating something new in health care. We are uniting industry-leading solutions to build an integrated care model that holistically addresses an individual's physical, mental and social needs - helping patients access and navigate care anytime and anywhere. As a team member of our Senior Community Care (SCC) team, we work to provide care to patients in nursing homes, senior housing and assisted living settings. This life-changing work adds a layer of support to improve access to care. We're connecting care to create a seamless health journey for patients across settings. Join us to start Caring. Connecting. Growing together.

You'll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Point of contact for all newly implemented Fully Integrated plans
• Provide coaching to OIT members
• Point of contact for day-to-day questions, contract exception requests
• Documentation, process alignment, report analysis of Claims department errors and performance metrics
• Additional administrative tasks to assist with management of team
• Maintain and update all OIT SOPs and Job aids
• Manage SME Q&A to support staff with their daily job function
• Manage Contract Exception requests
• Research, analyze, identify root cause correctly the first time, and coordinate resolution of claim issues with internal business partners
• Accountable for accurate documentation and routing of issues to appropriate resolution partners
• Provide feedback and education to SNFs to reduce recurrence of billing errors
• Provide feedback and education to internal teams to reduce processing and load errors
• Manage time effectively and balance workload and projects volume. The ability to prioritize, and multi-task effectively is required for success in this position
• Monitor progress of assigned claim issues and provide regular updates to the SNF contact
• Follow Team Standard Operating Procedures (SOP) and use Resource Guides during issue resolution
• Report the final resolution on assigned claim issues to the SNF contact. Communication must be accurate, clear, and effective
• Maintain compliance with all Federal/State regulations and UHG policies
• Effective written communication and ability to communicate in terms that the listener will understand

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 or equivalent work experience
• 5+ years of CSP claim processing
• 4+ years of health care/managed care experience
• 3+ years of experience with Medicare and Medicaid regulations
• 2+ years as a Provider Reimbursement Specialist
• Current CSP access
• Proficiency with MS Word, Excel, PowerPoint and Access

Preferred Qualifications:

• CSP claims Subject Matter Expert (SME)
• CSP benefit configuration
• CSP claims auditing

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary for this role will range from $72,800 to $130,000 annually based on full-time employment. We comply with all minimum wage laws as applicable.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

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