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 diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.
The position is responsible to work with the network healthcare providers on all operational issues before and after the center has signed an agreement with OptumHealth CMC. As the main operations contact for all levels of the provider organization, the incumbent is responsible for developing and maintaining strong relationships through initial orientation, ongoing training, contract knowledge and interpretation, management of member cases and provider’s Accounts Receivable. Also, responsible for process improvement, problem solving, proactive information gathering and communication, facilitating periodic meetings and maintaining quality and quantity service metrics.
You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:
Main operations contact for the provider for all issue resolution
Sets up and provides orientations and re-training to the centers. Identify training opportunities for facilities
Develop processes and tools to ease administration and improve the working relationship with the centers
Monitor and report on the level of center satisfaction with C.M.C.
Request and implement changes to improve internal processes
Identify changes that might be needed in the contract language/structure
Answers questions about the interpretation of the agreements
Assists in interpreting or completing a transplant center report
Questions information about transplant case dates
Coordination of the transplant center, C.M.C. and payer activities for patient
Specific questions about claims repricing or payment or special claims project
Gathers and maintains contact information at each center
Implement facility service metrics
Set claim processing rules according to contracts
Claim unrelated review
Facility relationship management
Promote the usage of EDI for all facilities and affiliated providers
Utilize the claims platform to:
Determine pricing methodology
Find information needed to view the inbound and outbound image
Fully understand claims inquiry for a patient
Understand case summary review
Manage the day-to-day call volume from facilities
Facilitate interaction with facility and client when high dollar cases and claims are received and treat as priority
Determine reconciliation, installments, auto adjudication and bundle billing
Identify when a claim was returned to provider in the XC process
Identify if EDI or paper submission
View provider and group information
Manage the role out, training, promotion, and continued monitoring of appropriate and continued usage of the provider website. The goal is to provide training materials to all facilities and provide training sessions to high volume users and high touch facilities
Support decisions made by the team and the organization with our facilities
Identify, support, and maintain our team as Claims Operations
Develop and update skills of Facets, Provider/Client Website and Excel
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)
1+ years of healthcare experience, preferably in managed care
1+ year of claims experience
1+ year of customer service experience
Preferred Qualifications:
Ability to build and leverage a network of experts to supplement one’s own expertise
Capable of managing a variety of complex issues while driving momentum of key projects
Soft Skills:
Strong strategic and business acumen and well-grounded in health care delivery systems
Negotiation and communication skills
*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, Maryland, Washington, or Washington D.C Residents Only: The hourly range for California, Colorado, Nevada, Connecticut, New York, New Jersey, Rhode Island, Hawaii, Maryland, 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
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