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Provider Contracted Rate Configuration - Remote

Company: UnitedHealth Group
Location: San Diego
Posted on: March 20, 2023

Job Description:

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 and start doing your life's best work.(sm)

Here's a way to leverage all of what makes you special. Your experience. Your potential. Your skills. And your approach to life. It's also an opportunity to build what's ahead. Because on the team at UnitedHealth Group, your potential and your impact can be career changing.

In this role, you'll bring a strong customer service focus to the installation and administration of highly complex provider Rate Configuration based upon Provider contracts/payment appendices as well as serving as a team resource to help newer team members learn job functions. You'll find the impact you want and the training, resources, backing and opportunities that you'd expect from a Fortune 5 leader.

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

Primary Responsibilities:

  • Ensure contracted and non-par provider network is built/setup as required by UHN and/or Healthplan
  • Prepare materials such as business requirements documentation and/or rate configuration loading guidelines
  • Audit Provider contracts/payment appendices and non-par provider against Source of Truth for adherence to quality measurers and reporting standards
  • Work independently on complex requests and help team members solve complex rate configuration problems using knowledge of platform limitations/requirements.
  • Flexible to shift priorities as required by business/projects
  • Audit work of others to identify and process/coordinate correction of loading errors

    This high-impact position is challenging. You will be working with configuration analysis to ensure loads into our system are accurate based on our provider contracts, so the ability to use data and facts to identify and solve a range of problems is critical to your success.

    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 or GED or equivalent work experience
    • 4+ years of experience including experience with facility or ancillary contract reimbursement rate configuration methodologies
    • 2+ years of experience with provider rate configuration in systems such as COSMOS and/or UNET/NDB
    • 2+ years of experience with provider rate configuration and ability to interpret provider contracts/payment appendices/facility payment appendices
    • Intermediate level of proficiency in Microsoft programs including Excel and Word

      Preferred Qualifications:

      • Undergraduate degree
      • 2+ years claim processing or resolution experience

        Careers with UnitedHealthcare. Work with a Fortune 5 organization that's serving millions of people as we transform health care with bold ideas. Bring your energy for driving change for the better. Help us improve health access and outcomes for everyone, as we work to advance health equity, connecting people with the care they need to feel their best. As an industry leader, our commitment to improving lives is second to none.

        California, Colorado, Connecticut, Nevada, New York City, or Washington Residents Only Residents Only: The hourly range for California, Colorado, Connecticut, Nevada, New York City, or Washington residents is $27.07 to $53.08. 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 employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

        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.

Keywords: UnitedHealth Group, San Diego , Provider Contracted Rate Configuration - Remote, Other , San Diego, California

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