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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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