Reimbursement Specialist

National Remote Position

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

Optum Insight is improving the flow of health data and information to create a more connected system. We remove friction and drive alignment between care providers and payers, and ultimately consumers. Our deep expertise in the industry and innovative technology empower us to help organizations reduce costs while improving risk management, quality and revenue growth. Ready to help us deliver results that improve lives? Join us to start Caring. Connecting. Growing together.

This position is full-time, Monday to Friday. Employees are required to have flexibility to work any of our shift schedules during our normal business hours of 8:00 am - 5:00 pm local time.

We offer weeks of on-the-job training. The hours of the training will be based on schedule or will be discussed on your first day of employment.

Primary Responsibilities:

• Ensure accurate Government reimbursement calculations, to include, but not limited to CMS DRG, facility specific factors and IME/Disproportionate Share, Tricare/VA, Medicaid APR DRG and OP reimbursement, rural health supplemental/differential reimbursement, as well as other government payment methodologies that have reimbursement implications
• Perform zero balance reviews of underpaid accounts to reduce outside vendor spend
• Auditing and updating Managed Care contracts including the maintenance and update of CPT/ASC/APC/RVU/CMG /IRF/DRG tables
• Reviewing payment variance to identify trends and root causes. Track and trend issues to resolution. Inform Management of all identified trends and issues
• Collaborate with various departments to address and resolve internal trends
• Escalate payer-related trends to Payer Solutions team and attend JOC (Join Operating Committee) with payers to resolve denial trends and/or payer-related issues to improve cash collection and reduce AR
• Triage questions from other departments regarding payer calculations
• Extensive Acute and Ambulatory claim review of expected versus actual payment variances to ensure accuracy and maximize reimbursement
• Stay up-to-date with federal, state, and payer-specific reimbursement policies and regulations
• Prepare and submit appeals/disputes for underpaid/denied claims
• Perform reviews, research and other duties independently or as requested by the Optum Leadership and Clients

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)
• Must be 18 years of age or older
• 3+ years of experience with hospital reimbursement methodologies, direct hospital managed care analysis or hospital collections experience
• 3+ years of experience in billing including CPT, ICD-10, HCPCS coding and EOB interpretation
• 3+ years of experience analyzing complex financial data and reimbursement trends
• 3+ years of experience in healthcare reimbursement regulations and payer policies
• Intermediate level of proficiency with Microsoft Office (Outlook, Excel, Word, PowerPoint, Visio, One Note, SharePoint)
• Ability to work full-time, Monday to Friday. Employees are required to have flexibility to work any of our shift schedules during our normal business hours of 8:00 am - 5:00 pm local time

Preferred Qualifications:

• Experience with automated Expected Reimbursement or Contract Management software systems
• Knowledge of legal and regulatory requirements associated with fee-for-service and managed care risk contracting for professional services to commercial, Medicaid and Medicare Advantage populations
• Knowledge to design compensation methodologies, calculate and evaluate compensation rates, and project the effect on revenues and expenses

Telecommuting Requirements:

• Ability to keep all company sensitive documents secure (if applicable)
• Required to have a dedicated work area established that is separated from other living areas and provides information privacy.
• Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service.

Soft Skills:

• High attention to detail to ensure accuracy in claims, payments, and reporting
• Ability to manage multiple tasks and priorities in a fast-paced environment
• Ability to organize and prioritize activities with specific attention to details and higher-level strategies, including effective time management skills
• Excellent verbal and written communication skills for interacting with internal teams and external payers
• Skilled in identifying problems, determining root causes, and implementing effective solutions

*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). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $29 - $52 hourly based on full-time employment. We comply with all minimum wage laws as applicable.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. 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.

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.