Provider Reimbursement Specialist
Company: UnitedHealth Group
Location: Houston
Posted on: June 25, 2022
Job Description:
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
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 that may require working with upstream
partners such as contracting, membership or product management to
identify root causes
- Researching and resolving capitation queries from Network
Mgmt., Provider Advocates, Finance and other constituents Primary
Responsibilities:
- 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
- Validate variance analysis for preliminary capitation runs to
ensure data is correct prior to running monthly capitation
- Review payment disputes to verify correct payments are made and
analyze data to determine root cause of errors and recommend system
changes, training and process improvements to prevent future
errors
- Identify and investigate requests or issues and problem solve,
perform process reviews and reconciliations, research conflicting
information or identify inaccurate data and work with appropriate
department as required. Escalate concerns to Managers and/or
upstream partners as required
- Support Contract Managers, Auditors, Network Management,
Provider Advocates, Finance and other constituents; by providing
research and resolution on capitation questions. - Also perform
outreaches and follow up timely on queries
- Provide support/mentorship to team members as needed to build
on knowledge of Capitation Operational processes, systems,
procedures and protocols
- Process manual adjustments as required to ensure the provider
is paid timely and accurately per contracts and create backup where
required for standard and non-standard monthly adjustments
- Trainer for Provider Advocates, Network Management and
Contracted Provider Groups for all regions as well as trainer for
new analysts
- Collaborate with IT to ensure fixes are run to update data in
the system and monitor outstanding tickets from submission to
closure
- Maintain current level of knowledge and 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 projects and system testing,
as assigned.
- Demonstrate excellent communication written and verbal,
excellent time management, problem solving, and organizational
skills
- Be a team player, collaborate well, develop and maintain
relations with peers, understand individual efforts will combine to
achieve overall success. Daily Practices:
- Demonstrate excellent and clear communication both written and
verbal
- Quick learner, with strong organizational skills, and an
ability to learn and effectively use multiple platforms and
systems.
- 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 where
priorities can change quickly.
- Participate and support projects and system testing, as
assigned
- Maintain 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 with strong organizational, data analysis and
problem-solving skills
- Demonstrate business focus and understanding of our cultural
values, vision, and strategy 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:
- Associate degree of higher -
- 3+ years Analysis, Accounting or Accounts Payable
experience
- Intermediate proficiency in Microsoft Excel (pivot tables and
formulas)
- Intermediate proficiency in Microsoft Access (SQL)
- 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:
- 3+ years Healthcare, Capitation or financial Analysis/Accounts
Payable experience
- Undergraduate degree or equivalent
- Ability to create and conduct effective presentations
- Experience in any of the following platforms ECap, NICE or CSP
Facets 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 $26.15
to $46.63. The salary 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 - 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, WAH, #RPO
Keywords: UnitedHealth Group, Houston , Provider Reimbursement Specialist, Accounting, Auditing , Houston, Texas
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