Retrospective Contract Auditor - Telecommute

Company: UnitedHealth Group
Location: Houston
Posted on: September 24, 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 is improving the lives of millions. Here, innovation is not about another gadget; it is about making health care data available wherever and whenever people need it, safely and reliably. There is no room for error. If you are looking for a better place to use your passion and your desire to drive change, this is the place to be. It's an opportunity to do your life's best work.(sm)

The Retrospective Contract Auditor is responsible for auditing provider contract language and system provider configuration. CME will analyze data collected across multiple databases to summarize, report, and provide clear communication to resolution and next steps. This position will support our overall growing customer base while providing leadership and management to the team.

You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

• 
  
• CME Quality Audit discipline which entails - organizing, tracking progress of audits and ensuring defect finding resolution
  
• Oversee post-load provider contract audits using various databases and/or source documents
  
• Validate provider configuration within Facets/NetworX
  
• Organize and track progress and findings of audit in Source of Truth Matrix (SOTM)
  
• Summarize audit results into presentation materials to present to senior leadership
  
• Research configuration issues and develop customers specific solutions
  
• Collaborate with key stakeholders to drive defect root cause analysis and remediation
  
• Mentor and coach peers
  
• Perform other duties as assigned
  
  
  This is an opportunity to truly challenge yourself. You'll work on many different aspects of Provider Networks in this role including manipulating data, working with prospective contract management team, provider contracting groups, managing projects, and navigating any issues with other teams such as research and escalations, provider configuration, claims operations, payment integrity and market operations leads.
  
  
  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:
  
  
  • 
    
  • Undergraduate degree or (3+ years of comparable work experience beyond the required years of experience may be substituted in lieu of an undergraduate degree)
    
  • 3+ years of experience in provider contracting -
    
  • 3+ years of experience with claims systems -
    
  • 3+ years of experience with contract submission, validation, and maintenance
    
  • Experience with Facets/NetworX
    
  • Solid knowledge of business processes that impact physician/facility/ancillary contract loading and auditing
    
  • Proficiency with all physician/facility/ancillary contract reimbursement methodologies
    
    
    Preferred Qualifications:
    
    
    • 
      
    • Project management experience
      
      
      
      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 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, Connecticut or Nevada Residents Only: The salary range for Colorado residents is $66,100 to $118,300. The salary range for Connecticut / Nevada residents is $72,800 to $129,900. 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 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.

Keywords: UnitedHealth Group, Houston , Retrospective Contract Auditor - Telecommute, Accounting, Auditing , Houston, Texas