UnitedHealth Group is hiring

Senior Provider Reimbursement Representative job at UnitedHealth Group, New York

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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)

You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges or work onsite if you reside in Cypress, CA.

 Summary of Position:

  • Responsible for processing capitation (ECAP, NICE or CSP Facets – C&S)
  • Conducting variance analysis and reporting to support the monthly capitation payments to our Medical Groups, Hospitals and Ancillary providers or vendors. 
  • Analyzing month on month data, identifying, Documenting and Resolving issues to ensure accurate and timely payments.
  • Researching variances based on upstream impacts from membership and contracting. 
  • Resolution of issues may require working with upstream partners such as contracting, membership or product management to identify root cause
  • Researching and resolving capitation queries from Network Mgmt., Provider Advocates, Finance and other constituents.

Primary Responsibilities:

  • Learn and build on knowledge of Capitation Operational processes, systems, procedures and protocols. Learn and effectively use multiple platforms and systems
  • Perform and monitor production jobs, audit queries; run and analyze reports/ variances, ensure payments are processed accurately according to contractual agreements, tight deadlines and defined Capitation Calendar schedule
  • Produce variance analysis for preliminary capitation runs to ensure data is correct prior to running monthly capitation
  • Process manual adjustments and review Cap Payments to ensure the provider is paid timely and accurately per contracts and create backup where required.
  • Ensure relevant Provider data and reporting is available to Provider according to scheduled deadlines.
  • Research and resolve capitation questions from Network Mgmt., Provider Advocates, Finance and other constituents; Also perform outreaches, follow up timely on queries.
  • Independently problem solve, perform process reviews and reconciliations, research conflicting or identify inaccurate data.
  • Produce various deep-dive data analyses and trend reporting, and research and explain variances in relation to membership and contract changes and capitation expenses
  • Collaborate with IT to ensure fixes are run to update data in the system and monitor outstanding tickets from submission to closure.
  • Investigate non-standard /complex requests and problems, with some assistance from Management; Identify concerns and report to Managers and/or upstream partners for resolution
  • Apply good judgement to challenge our current processes/procedures and submit recommendations to develop more efficient solutions for the team and higher quality for providers
  • Identify and document process improvements, automation opportunities and collaborate with Team and IT on same.
  • Collaborate with business partners to identify innovative solutions for resolving and decreasing escalated provider issues
  • Participate and support applicable ad hoc projects and system testing, as assigned.
  • Maintain current knowledge of business strategies, protocols, and procedures (e.g. attend training, team meetings, read email communications)
  • Demonstrate excellent communication written and verbal, excellent time management, problem solving, and organizational skills
  • Draw on experience in business/finance analysis and present data/recommendations to management, providing operational analysis utilized for decision making
  • Be a team player

Daily Practices:

  • Demonstrate excellent and clear communication both written and verbal, excellent time management and problem-solving ability.
  • Quick learner, with strong organizational and recall skills, and an ability to learn and effectively use multiple platforms and systems
  • Ability to independently problem solve, research conflicting or identify inaccurate data
  • Ability to prioritize and effectively handle multiple priorities and to learn and effectively use multiple program applications and systems quickly and efficiently
  • Exhibit Energetic, diplomatic, self-motivated, and high commitment to drive to results in a challenging environment
  • Participate and support applicable ad hoc projects and system testing, as assigned
  • Maintains current knowledge of business strategies, protocols, and procedures (e.g. attend training, team meetings, read email communications)
  • Ability to work independently, prioritize and organize own work to meet deadlines; and also as a team player keen to ensure overall departmental success.
  • Demonstrate adaptability in a highly changing environment, quickly shifting focus as priorities change
  • Demonstrate business focus and understanding of our cultural values, vision, and strategy
  • Team Player with ability to work independently whilst focusing on overall Departmental success, with strong organizational, data analysis and problem-solving skills.

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 School Diploma/GED or higher 
  • 2+ years Analysis, Accounting or Accounts Payable experience
  • Intermediate proficiency with Excel VLOOKUP and Pivot Tables
  • Full COVID-19 vaccination may be an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation

Preferred Qualifications:

  • Capitation or Healthcare Financial Analysis/Accounts Payable experience 
  • Microsoft Access experience reporting /databases

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 Optum. Here's the idea. We built an entire organization around one giant objective; make the health system 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) 

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

Colorado, Connecticut or Nevada Residents Only: The salary range for Colorado residents is $21.68 to $38.56. The salary range for Connecticut / Nevada residents is $23.94 to $42.40. 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 


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 Keywords: Remote, work from home, work at home, WFH, #RPO


Job country: United States

City: New York

Category: Business Operations Specialists, All Other

Location: New York, NY, United States

Job posted 2022-06-04

This job is expired

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