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Quality Reimbursement Specialist - Telecommute job at UnitedHealth Group, San Jose

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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)

The Quality Reimbursement Specialist is responsible for developing programs, policies and strategies to ensure that contracted rates and reimbursement policies are applied accurately for company affiliates. Quality Reimbursement Specialists analyze claims, pre and post payment, to ensure contracts and reimbursement policies and procedures are priced accurately; review claim disputes to verify correct pricing and analyze claim inquiry data to determine root cause of errors; recommend system changes, training and process improvements to prevent future errors; work with both internal and external customers to identify and resolve complex problems; assist company affiliates with initial deployment and ongoing support of systems and processes to leverage national network rates and policies. Other responsibilities include fee schedule and contract template maintenance.
 
The Quality Reimbursement Specialist supports the Audit Manager in developing audit processes to validate configuration and rates compared to the source of truth. In addition, this position determines root causes for any errors as well as documents business requirements for any potential automation to reduce errors in the future.  The Quality Reimbursement Specialist also researches & interprets government web sites for changes / updates to policy and procedures to ensure UnitedHealth Group has accurate information relative to Medicaid provider methodologies, rates, and reimbursement policies.
 
The Quality Reimbursement Specialist will present written and verbal audit findings to internal business partners related to audit results, which include an overview of the supporting documentation and assessment of root cause failures.  Assess and make recommendations for process improvements to remediate agreed to errors and improve claim processes and payment accuracy.  The Quality Reimbursement Specialist is expected to provide written and verbal audit findings to external business partners (audit firms and customers) related to sample results, providing UHC policy/position in externally focused appropriate messaging.

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

Primary Responsibilities:

  • Ensure teams are obtaining, validating, and analyzing data which impacts reimbursement
  • Drive program design and implementation to improve quality and affordability through improvements in appropriateness and effectiveness
  • Proven leadership skills, ability to mentor and coach others
  • Independently research artifacts, gather data, involve appropriate stakeholders, lead meetings, document agenda minutes and negotiate with others to arrive at an amicable solution 
  • Promote a mindset and culture within the team that embraces identifying, owning, and solving issues, driving quality, improving performance, and improving the customer experience
  • Research and develop programs, policies, and strategies to ensure that Medicaid provider methodologies, rates and reimbursement policies are applied accurately for company affiliates
  • Participate in the development and implementation of C&S Reimbursement business strategy
  • Develop and maintain policies, procedures, and training documentation
  • Proven capability to work with people at all levels within the organization
  • Facilitate meetings with multiple levels of management
  • Assess and interpret customer needs and requirements
  • Identify solutions to requests and problems
  • Solve problems and / or conduct moderately complex analyses
  • Work with minimal guidance
  • Translate concepts into practice


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:

  • Undergraduate degree or equivalent experience
  • 3+ years of experience working with a managed care organization or health insurer; or as a consultant in a network/contract management role, such as contracting, provider services, etc.
  • 3+ years of experience in claims research, analysis, and reporting
  • 3+ years of experience researching Medicaid/Medicare provider reimbursement regulations
  • 2+ years of experience in data analysis
  • 2+ years of experience working with claims systems (CSP Facets/Cosmos)
  • 1+ years of audit experience
  • Advanced experience using Microsoft Excel and Word with proficient skills in all other Microsoft business applications and solid PC skills

Preferred Qualifications:

  • 1+ years of SQL experience, preferably MS SQL Server
  • Capability to work with people at all levels in an organization
  • Exceptional organizational skills and attention to detail
  • Solid teamwork, interpersonal, and administrative and customer service skills
  • Ability to effectively multitask, effectively managing multiple projects and initiatives
  • Excellent verbal and written skills with the ability to clearly articulate information in a clear and concise manner


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 hourly range for Colorado residents is $26.15 to $46.63. The hourly range for Connecticut / Nevada residents is $28.85 to $51.30. 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.


Job country: United States

City: San Jose

Category: Business Operations Specialists, All Other

Location: San Jose, CA, United States

Job posted 2022-06-04

This job is expired

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