Expanding access to affordable, high quality health care starts here. This is where some of the most innovative ideas in health care are created every day. This is where bold people with big ideas are writing the next chapter in health care. This is the place to do your life's best work.(sm) The Director of Provider Reimbursement is responsible for developing programs, policies and strategies to ensure that contracted rates and reimbursement policies are applied accurately for company affiliates. Directors of Provider Reimbursement will 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. This role will be accountable for helping drive financial modeling and client facing presentations denoting Optum's affordability services. In addition this role will support reconciliation teams for both pharmacy and client contract management in optimizing the outcomes across the entire book of OptumRx business. Primary Responsibilities:Develop and execute strategies for a function or discipline that span a large business unit or multiple markets / sites Direct others to resolve business problems that affect multiple functions or discipline Product, service or process decisions are most likely to impact multiple functions and/or customer accounts (internal or external) This role will support strategy, setup & maintenance for large clients within the OptumRx portfolio Candidates applying for this role will have financial or economic modeling experience, client or executive material development and presentation experience Developing and leading financial modeling teams will benefit all applicants
Required Qualifications: Undergraduate degree 6+ years health plan or PBM experience Advanced proficiency in MS Office (Excel, Word & PowerPoint)Preferred Qualifications:Ability to effectively multi task, effectively managing multiple projects and initiatives Exceptional organizational skills and negotiation skills Excellent verbal and written skills with the ability to clearly articulate information in a clear and concise mannerCareers with OptumRx. We're one of the largest and most innovative pharmacy benefits managers in the US, serving more than 12 million people nationwide. Here you'll fill far more than prescriptions. As a member of one of our pharmacy teams, you're empowered to be your best and do whatever it takes to help each customer. You'll find unrivaled support and training as well as a wealth of growth and development opportunities driven by your performance and limited only by your imagination. Join us. There's no better place to help people live healthier lives while doing your life's best work.(sm) 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. Job Keywords: Provider Reimbursement, PBM, Claims, Leader, Director, Manager, Eden Prairie, MN, Minnesota
Our mission is to help people live healthier lives and to help make the health system work better for everyone.- We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities. - We work with health care professionals and other key partners to expand access to quality health care so people get the care they need... at an affordable price. - We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions.