Provider Reimbursement Specialist

Provider Reimbursement Specialist

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.

Optum has an immediate opening for a Provider Reimbursement Specialist

Schedule: Mon - Fri, 8:00AM - 5:00PM any time zone that you reside within

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

Primary Responsibilities

• Research and develop applicable business rules that support product reimbursement methodologies and policies for existing and new business opportunities.
• Develop and submit fee schedules and/or provider rates to claim pricing platforms.
• Perform post-load quality analysis review on relevant claim platform submissions and provide correction instructions if necessary
• Write technical specifications or business requirements that support the development of business applications or existing system enhancements
• Perform and/or review user acceptance testing of relevant applications (e.g., support fee schedule; rate submissions; fee builder tool; claim editing system; claim pricing system)
• Write internal operational and/or reimbursement policies that support global functions.
• Work with business partners to develop and/or create provider agreements and payment appendices to reflect terms of the provider's reimbursement strategies
• Research new opportunities to improve operating efficiencies, implement medical cost savings and/or reduce administrative expenses, and provide appropriate recommendations to applicable audiences.
• Review State websites for the markets assigned on a weekly basis to research any Fee Schedule changes and submit to PCRL to ensure most appropriate pricing is documented and loaded in our systems.
• Performs other duties as assigned

What are the reasons to consider working for UnitedHealth Group? Put it all together - competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include:

• Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays
• Medical Plan options along with participation in a Health Spending Account or a Health Saving account
• Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage
• 401(k) Savings Plan, Employee Stock Purchase Plan
• Education Reimbursement
• Employee Discounts
• Employee Assistance Program
• Employee Referral Bonus Program
• Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)

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
• 2+ years of experience working on CSP FACETs
• 1+ years of experience supporting professional reimbursement
• 1+ years of experience with provider contracts and/or interpretation of the State requirements but not limited to RFPs and contracts
• Intermediate to Advanced level of proficiency in Microsoft programs including Excel and Word
• Access to a designated quiet workspace in your home (separated from non-workspace areas) with the ability to secure Protected Health Information (PHI)
• Live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service

Preferred Qualifications:

• Experience in medical billing, claims processing or contract installation including experience with professional reimbursement methodologies
• 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
• Experience in a role exposing you to provider contract
• Undergraduate degree or equivalent

Soft Skills:

• Ability to work independently and as a team, and maintain good judgment and accountability
• Demonstrated ability to work well with health care providers and team members
• Strong organizational and time management skills
• Ability to multi-task and prioritize tasks to meet all deadlines
• Ability to work well under pressure in a fast-paced environment
• Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying information in a manner that others can understand, as well as ability to understand and interpret information from others

*All Telecommuters 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 hourly pay for this role will range from $29.00 to $52.00 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

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.

#RPO #GREEN