Provider Reimbursement Representative – National Remote

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 to start Caring. Connecting. Growing together.
The Provider Reimbursement Representative is responsible for answering Incoming calls from Providers while ensuring a high level of Customer Service and maximizing productivity on claim adjustments. Provider Reimbursement Representatives support those who analyze claims, pre and post payment, to ensure contracts and reimbursement policies and procedures are priced accurately; review claim disputes to verify correct pricing and analyze claim inquiry data to determine root cause of errors; recommend system changes, training and process improvements to prevent future errors; work with both internal and external customers to identify and resolve complex problems; assist company affiliates with initial deployment and ongoing support of systems and processes to leverage national network rates and policies.
You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:

Provide the very best Customer Service to Internal / External customers Via VCC

Resolve Customer Service inquiries

Provider participation status

Provider discount disputes

Adjust claims according to specified procedures and standards, meeting all position production and quality standards

Apply knowledge / skills to activities that often vary from day – to – day

Demonstrate a high level of knowledge and skills in own function

Require little assistance with complex claim adjustments

Solve routine and complex problems on own

Prioritize and organize own work to meet agreed upon deadlines

Work with others as part of a team

Complete large dollar claim adjustments while maintaining a high level of quality

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) OR 4+ years of NDB, ppoONE, iCES and UHC claims experience/knowledge

2+ years of experience analyzing and handling inquiries for UHC priced claims

2+ years of UHC provider contract experience/knowledge

2+ years of experience processing HCFA and UB claims

2+ years of knowledge or experience with UMR CPS processes

1+ years of NDB, ppoONE, iCES and UHC claims experience/knowledge

Intermediate level of proficiency with Microsoft Word (create, edit, and update documents)

Preferred Qualifications:

2+ years of experience with VCC

Ability to utilize Microsoft Access to create forms and reports while storing tables

Previous UHN Plan experience

Soft Skills:

Strong Interpersonal Skills: ability or desire to learn how to run small group meetings

Strong business, written and oral communication skills

Ability to handle a fast-paced environment with pressure based on project deadlines

Candidate needs to be organized and detail oriented

Ability to communicate efficiently with providers via phone in regards to UHC contract/UMR claim issues

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.
For more information on our Internal Job Posting Policy, .
California, Colorado, Nevada, Connecticut, New York, New Jersey, Rhode Island, Hawaii, Washington or Washington, D.C. Residents Only: The hourly range for California, Colorado, Nevada, Connecticut, New York, New Jersey, Rhode Island, Hawaii, Washington or Washington, D.C. residents is $19.47 to $38.08 per hour. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. 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.
Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.
Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
At 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.
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UnitedHealth Group