Senior Provider Reimbursement Specialist - Remote

UnitedHealth Group•Derry, NH

1d•$72,800 - $130,000•Remote

About The Position

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.

Requirements

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

Nice To Haves

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

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