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 Senior Provider Reimbursement Representative is responsible for activities associated with developing programs, policies, and strategies to ensure that contracted rates and reimbursement policies are applied accurately for company affiliates. The Senior 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.
There’s a heavy analytical aspect to this role, involving running, reporting, and importing metrics within MS Access. You’ll be expected to provide accurate and effective reasoning as you help drive fee schedule builds, reimbursements, configurations, and maintenance.
You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:
Assist with daily inventory review and assignment
Participate on the Senior Repricing Committee and with special repricing projects
Cover stop loss rush repricing shifts as late as 9pm CT as assigned
Participate in macro development, testing and training for the team
Work with team members on challenging system processes for complex claims
Analyze team processes for workplace efficiencies
Team Lead duties daily – including rush email boxes, macro, team member question emails, and other duties as assigned by management
Review and recommend system changes on provider contracts that appear inaccurate in the NDB (UHC Provider Network Database)
Prioritize and organize own work to meet agreed upon deadlines
High Dollar Methodology Reviews (Ticklers)
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)
3+ years of experience with UMR CPS processes
2 + years of experience with NDB, ppoONE, iCES and UHC claim pricing
2+ years of experience analyzing and handling inquiries or escalated issues for UHC priced claims
2+ years of experience with UHC provider contract
2+ years of experience with repricing HCFA or UB claims
Intermediate level of proficiency with Microsoft Office Suite (Word, Excel)
Preferred Qualifications:
1+ years of experience with Surprise Medical Bill processes
Soft Skills:
Strong research and analytical 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
Organized and detail oriented
*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.
For more information on our Internal Job Posting Policy, .
The salary range for this role is $23.70 to $46.35 per hour based on full-time employment. 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.
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.
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UnitedHealth Group
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