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Migration & Implementation Provider Reimbursement Configuration SME (Facets) - Remote job in Indianapolis at UnitedHealth Group

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Migration & Implementation Provider Reimbursement Configuration SME (Facets) - Remote at UnitedHealth Group

Migration & Implementation Provider Reimbursement Configuration SME (Facets) - Remote

UnitedHealth Group Work from Home/Remote Full-Time

UnitedHealthcare is a company that's on the rise. We're expanding in multiple directions, across borders and, most of all, in the way we think. Here, innovation isn't about another gadget, it's about transforming the health care industry. Ready to make a difference? Make yourself at home with us and start doing your life's best work.(sm)

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

Primary Responsibilities:

  • Review, interpret and/or verify contract language, information, and intent to load information into systems properly
  • Ensure contract templates can be administered across operations (pricing config, claims, etc.)
  • Communicate identified discrepancies to Network Mgmt, Contracting and Pricing Requirement teams
  • Reviews company specific, CMS specific, State specific and competitor specific medical policies and reimbursement policies
  • Review pricing configuration structure and provider billing set-up to ensure contract loading accuracy
  • Identify multiple potential solutions to resolve claims issues
  • Conduct testing of proposed solutions and/or changes made to determine their effectiveness and make necessary modifications 
  • Review recommended or requested solutions and provide appropriate approvals needed to implement corrective solutions
  • Conduct and/or participate in regular meetings with internal and/or external business partners to share relevant information and discuss pricing requirements
  • Create and/or provide loading documentation to instruct internal business partners on contract/non par loading procedures 
  • Leads projects related to provider reimbursement initiatives
  • Works with provider contracting staff when new/modified reimbursement contracts are needed
  • Performs pre-adjudication claims reviews to ensure proper coding was used
  • Communicate and/or collaborate with internal business partners to identify process improvement opportunities
  • Perform SQL queries to pull reports when necessary 
  • Assist with audits and other quality controls to proactively identify issues
  • Perform audits of new and/or existing provider contracts to ensure accuracy of set up accurately into appropriate systems (e.g., Facets NetworX, NDB, COSMOS, UNET, NICE, ppoOne)
  • Prioritize workloads

This high-impact position is challenging. You will be working with configuration analysis to ensure loads into our system are accurate based on our contracts, so the ability to use data and facts to identify and solve a range of problems is critical to your success.

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 Diploma / GED or higher
  • 4+ years of experience with Facility/Ancillary and Professional Provider reimbursement methodologies without loading guidelines into various platforms
    • Facets (NetworX) knowledge/experience
  • Subject Matter Expert (SME) in Facility/Ancillary and Professional Provider Configuration Reimbursement as no training is offered
  • Optum Rate Manager experience with Medicare, State, and custom records
  • 3+ years of experience with claims processing systems platforms, such as Facets NetworX, COSMOS, NDB/UNET, NICE, ppoOne, etc. (familiar with CPT, HCPCS, DRG, Revenue, ICD-10, etc.)
  • MS Office: Excel, Word, and some MS Access
  • Experience with CMS Guidelines and State Specific Pricing

Preferred Qualifications:

  • Self-directed and experience multi-tasking effectively between two or more activities or sources of information
  • Managing multiple projects concurrently while maintaining a high level of quality and commitment to project timeframes
  • Communicate and collaborate with internal customers
  • Critical thinking skills

To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment

Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 5 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can do your life's best work.(sm)

Colorado, Connecticut or Nevada Residents Only: The salary range for Colorado residents is $66,100 to $118,300. The salary range for Connecticut / Nevada residents is $72,800 to $129,900. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

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

Recommended Skills

  • Auditing
  • Billing
  • Business Process Improvement
  • Claim Processing
  • Content Management
  • Critical Thinking
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