Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.
This position will primarily be responsible for review and approval of variance analyses and reporting to support the monthly capitation payments to our Medical Groups/IPAs, Hospitals and Ancillary providers or vendors. This would include researching variances based on upstream impacts from membership and contracting and guiding staff. Analysis will include review trending of month over month data, identifying, documenting, and resolving issues to ensure accurate and timely payments, in addition to approving adjustments to support this. Work with business partners and IT to identify root cause, ensure resolution and remediation of issues.
Department is responsible for processing capitation for four different systems – NICE, Enterprise Capitation (ECap), Community & State (CSP) Facets and UCap, as well as three separate lines of business Medicare & Retirement, Medicaid and Employer & Individual. The capitation processing includes a multitude of payment methodologies such as Percent of Premium, Age/Sex/Benefit, Age/Sex/Co-Pay, Age/Sex adjusted and Flat per member per month (PMPM), and tiered capitation with various due dates by region and product.
You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:
Learn and effectively use multiple platforms and systems
Supervise and manage staff activities which include:
Monitoring of production jobs to ensure capitation data is produced timely and accurately
Reviewing variance analyses for preliminary capitation runs to ensure data is correct prior to running monthly capitation
Identifying fallout and issues and report to Managers and/or upstream partners for resolution
Reviewing various data analyses and trend reporting based on prior month’s capitation
Researching and explaining variances relative to membership changes, contract configuration and capitation expense per pre-determined thresholds
Presenting findings and recommendations to Management/Finance/UnitedHealth Network for resolution
Reviewing and approving manual adjustments and supporting backup documents to ensure provider is paid timely and accurately per contractual agreement
Approving Payment Authorizations per contractual due dates
Ensuring adjustments are accurately coded per type and reason code
Approving schedules to support Finance and monthly Metrics Package
Researching and resolving capitation questions from Network, Finance and other constituents
Support applicable ad hoc projects including system and User Acceptance Testing (UAT), as assigned
Build and expand knowledge of capitation business strategies, rules, and procedures, working towards becoming a department SME
Be a team player; understand individual efforts will combine to achieve overall success
Mentor and assist staff on their career progression and development
Use good judgment to challenge our current processes/procedures and submit recommendations to develop more efficient solutions for the team and higher quality for providers
Assist with reports and analysis to support financial audits and accruals as required by Finance
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:
5+ years of experience within a financial, analytical, or data analysis role
Intermediate Microsoft Excel – such as pivot tables and complex formulas
Proven solid data analysis skills including Microsoft Access/SQL
Proven ability to prioritize and effectively handle multiple and shifting priorities
Proven ability to independently problem solve, research and identify inaccurate data, spot anomalies and trends
Demonstrated excellent communication written and verbal, time management, problem solving, and organizational skills
This role is an onshore position but will be working with staff in multiple US time zones in addition to offshore resources in India and Ireland so flexibility in work schedule is required
Preferred Qualifications:
Experience of Business Analysis, Accounting, Accounts Payable or Healthcare experience
Capitation or Healthcare Financial Analysis experience
Experience with advanced analytical tools such as SAS
Experience with data visualization tools such as Tableau and Microsoft Power BI
Experience utilizing internal UHG applications such as NICE, NDB, COSMOS, CSP Facets, ECap, UCap, Cirrus or other large mainframe or cloud-based transactional applications
Demonstrated ability to learn new computer applications quickly and efficiently
*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you’ll find a far-reaching choice of benefits and incentives. The salary for this role will range from $89,900 to $160,600 annually based on full-time employment. We comply with all minimum wage laws as applicable.
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.
UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
UnitedHealth Group is a drug – free workplace. Candidates are required to pass a drug test before beginning employment.
UnitedHealth Group
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