Provider Reimbursement Specialist

UnitedHealth Group•Eden Prairie, MN

3d•$29 - $52•Remote

About The Position

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

Requirements

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

Nice To Haves

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
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

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.