Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.(sm)
Everybody likes winning. Right? We sure do. And UnitedHealth Group has the right combination of leadership and innovation to ensure more wins in the marketplace everyday. As we take on new customers, we're driving new opportunities for people like you. More and more employers are turning to us for a higher level of quality and performance in health care services. Now, we invite you to help us welcome these new members as you help install assigned benefits accounts. You'll be responsible for overall employer contract loading using various databases and/or source documents. We provide the training, resources and opportunities you'd expect from a Fortune 7 leader.
You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
- Load provider configuration requirements in Facets to ensure claims pay correctly related to provider contracts, agreements, authorization and referrals
- Interpret provider contracts, fee schedules and rates in order to set up configuration correctly to ensure providers are paid according to the source of truth(s)
- Collaborate with stakeholders to gather, assess, interpret and document customer needs and requirements
- Work with local markets on escalations to resolve configuration issues
- Partner with documentation specialist to assist with job aide/SOP content related to provider configuration processes
- Identify and analyze issues to provide solutions to respond to internal and external customer needs
- Research claims issues to determine configuration gaps, update configuration as applicable
- Audit configuration against contract requirements to verify configuration following source documentation
- Serve as a SME resource to other team members and business partners related to contract configuration
- Consistently meet established productivity, schedule adherence, and quality standards while maintaining expected attendance
- Assist with monthly capitation payments and reconciliations
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.
- 2+ years of experience working with Medicare, Medicaid or Commercial provider contract configuration
- 2+ years of experience working with Core Facets database pricing
- 2+ years of experience resolving claim pricing issues or other configuration defects in Facets
- Proficiency in Microsoft Word, Excel, and Outlook
- Computer proficiency including, but not limited to, ability to learn new computer system applications
- Ability to multi-task
- If you need to enter a work site for any reason, you will be required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or similar UnitedHealth Group-approved symptom screener. When in a UnitedHealth Group building, employees are required to wear a mask in common areas. In addition, employees must comply with any state and local masking orders
- 2+ years of experience configuring DOFR (Division of Financial Responsibility) in Core Facets
- 2+ years of health insurer experience resolving provider claims adjudication issues
- Medicaid provider contract configuration and state fee schedules
- Experience with Medicare medical benefit plans
- Claims adjudication knowledge
- Capitation knowledge and experience
- Data analytics
- Audit experience
- Experience with COSMOS or UNET or NICE
- Experience building and running SQL queries using tools such as MS Access, Query Builder, or similar
- Knowledge of supporting tools from Trizetto and other vendors such as CMU or similar application
Helping us drive ever higher levels of performance can take your career to a whole new place. Find out more. Explore today and learn how you can start doing your life's best work.(sm)
Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)
OptumCare is committed to creating an environment where physicians focus on what they do best: care for their patients. To do so, OptumCare provides administrative and business support services to both owned and affiliated medical practices which are part of OptumCare. Each medical practice part and their physician employees have complete authority with regards to all medical decision-making and patient care. OptumCare’s support services do not interfere with or control the practice of medicine by the medical practices or any of their physicians.
Colorado Residents Only: The hourly range for Colorado residents is $25.63 to $45.72. Pay is based on several factors including but not limited to education, work experience, certifications, etc. As of the date of this posting, In addition to your salary, UHG offers the following benefits for this position, subject to applicable eligibility requirements: Health, dental, and vision plans; wellness program; flexible spending accounts; paid parking or public transportation costs; 401(k) retirement plan; employee stock purchase plan; life insurance, short-term disability insurance, and long-term disability insurance; business travel accident insurance; Employee Assistance Program; PTO; and employee-paid critical illness and accident insurance.
*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy
Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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.
OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
Job Keywords: Provider Configuration Analyst, Medicare, Medicaid, Provider Contract Configuration, Core Facets, Database Pricing, Telecommute, Telecommute, Telecommuting, Telecommuter, Work From Home, Work At Home, Remote