Positions in this function are responsible for the reimbursement analysis, development and installation of provider fee schedules and testing of prospective payment system (PPS) pricing structures, including, but not limited to: downloading schedules from CMS, creating valid PPS (i.e., DRG, APC, ESRD, ASC, etc.) test case scenarios, researching & resolving structural issues, manipulation of large data sets, database loading, and preparation of pricing materials such as administrative documents and customer education materials. Positions are responsible for overall contract loading using various databases and/or source documents. May research installation issues & develop customer specific resolutions. May include auditing contract loads for adherence to quality measures and reporting standards.
You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities:
- Anticipates customer needs and proactively develops solutions to meet them
- Serves as a key resource on complex and/or critical issues
- Interprets regulatory / contractual requirements related to reimbursement
- Solves complex problems and develops innovative solutions
- Performs complex conceptual analyses
- Reviews work performed by others and provides recommendations for improvement
- Forecasts and plans resource requirements
- Authorizes deviations from standards
- May lead functional or segment teams or projects
- Provides explanations and information to others on the most complex issues
- Motivates and inspires other team members
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:
Careers with Optum.
- Undergraduate degree or equivalent experience
- 3+ years of reimbursement experience in professional and facility (Ambulatory Surgery Centers/ASC, Hospitals, Dialysis, Home Health)
- Intermediate experience in MS Oracle/SQL
- Advanced experience with Excel and Access
- Experience with Facets system
- Experience creating and maintain fee schedules
- Experience Troubleshooting claim issues related to fee schedule pricing
- Experience working with large data sets
- 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
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)
Colorado Residents Only: The hourly range for Colorado residents is $31.15 to $55.77. 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: 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: Fee Schedule Analyst, Facets, Healthcare, Optum, Telecommute, Work from Home