Provider Reimbursement Config - Facets, Core or NetworX- Remote

Company: UnitedHealth Group
Location: Miami
Posted on: March 20, 2023

Job Description:

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us and start doing your life's best work.(sm)As a key member of PDO Migration & Strategy team, you will embrace the opportunity to use your Facets (Core or NetworX) knowledge while working multiple migration and implementation projects simultaneously. --Your ability to shift priorities to meet business requirements will allow you to be a part of a dynamic and growing team.You'll enjoy the flexibility to work remotely* from anywhere within the U.S. as you take on some tough challenges. Needs to live in USPrimary Responsibilities:Review, interpret and/or verify contract language, information, and intent to load information into systems properlyEnsure contract templates can be administered across operations (pricing config, claims, etc.)Communicate identified discrepancies to Network Mgmt, Contracting and Pricing Requirement teamsReviews company specific, CMS specific, State specific and competitor specific medical policies and reimbursement policiesReview pricing configuration structure and provider billing set-up to ensure contract loading accuracyIdentify multiple potential solutions to resolve claims issuesConduct 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 solutionsConduct and/or participate in regular meetings with internal and/or external business partners to share relevant information and discuss pricing requirementsCreate and/or provide loading documentation to instruct internal business partners on contract/non par loading procedures--Leads projects related to provider reimbursement initiativesWorks with provider contracting staff when new/modified reimbursement contracts are neededPerforms pre-adjudication claims reviews to ensure proper coding was usedCommunicate and/or collaborate with internal business partners to identify process improvement opportunitiesPerform SQL queries to pull reports when necessary--Assist with audits and other quality controls to proactively identify issuesPerform 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 workloadsThis 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 school diploma / GED or higher
• 4+ years of experience with Facility/Ancillary and Professional Provider reimbursement methodologies without loading guidelines into various platforms
• 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.)
• Facets (NetworX) knowledge/experience
• Optum Rate Manager experience with Medicare, State, and custom records
• Experience with CMS Guidelines and State Specific Pricing
• Subject Matter Expert (SME) in Facility/Ancillary and Professional Provider Configuration Reimbursement as no training is offered
• MS Office: Excel, Word, and some MS AccessPreferred 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
  • Demonstrated critical thinking skillsCareers with UnitedHealthcare. Work with a Fortune 5 organization that's serving millions of people as we transform health care with bold ideas. Bring your energy for driving change for the better. Help us improve health access and outcomes for everyone, as we work to advance health equity, connecting people with the care they need to feel their best. As an industry leader, our commitment to improving lives is second to none.California, Colorado, Connecticut, Nevada, New York City, or Washington Residents Only: The salary range for California, Colorado, Connecticut, Nevada, New York City, or Washington residents is $67,800 to $133,100. 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 employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter PolicyAt UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.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.

Keywords: UnitedHealth Group, Miami , Provider Reimbursement Config - Facets, Core or NetworX- Remote, Other , Miami, Florida