Position Description: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) Primary Responsibilities:Apply knowledge / skills to a range of moderately complex activities. Demonstrate great depth of knowledge / skills in own function.Sometimes act as a technical resource to others in own function.Proactively identify solutions to non - standard requests. Solve moderately complex problems on own.Work with team to solve complex problems.Plan, prioritize, organize and complete work to meet established objectives.May coordinate work of other team members. Responsible for data collection of reimbursement information from Third Party Payers, accountable for completeness and integrity of data.Conduct routine audits of Third Party Payers to discern the root cause of Fee Schedule Reimbursement differences, Denial concerns, and identifying Pricing issues related to reimbursement rates.Provide data reporting on reimbursement issues with the ability to communicate findings to Leadership and Operational Teams.Maintain Analysis Log of all findings and tracking to the completion of data collection on Reimbursement projects and provide status reports.Work closely with all levels of staff within Optum360 and Quest Diagnostics on projects identifying and capturing Reimbursement Opportunities.Recognize Reimbursement improvement opportunities with emphasis on Cash Realization, Denial Reduction and improving data management techniques.Generate ad - hoc reports for leadership and analytical staff for special projects and routine analysis.Develops programs, policies and strategies to ensure that contracted rates and reimbursement policies are applied accurately for company affiliates. Analyzes claims, pre and post payment, to ensure contracts and reimbursement policies and procedures are priced accurately. Reviews claim disputes to verify correct pricing and analyzes claim inquiry data to determine root cause of errors; recommends system changes, training and process improvements to prevent future errors. Works with both internal and external customers to identify and resolve complex problems. Assists company affiliates with initial deployment and ongoing support of systems and processes to leverage national network rates and policies. Fee schedule and contract template maintenance is also included in this function.
Required Qualifications:High School Diploma / GEDHealthcare customer service experience.Intermediate proficiency with Microsoft Office (Excel, Word, and PowerPoint). Soft Skills:Strong research and analytical skills. Excellent interpersonal skills at both an individual and team level. Excellent written and verbal communication skills.Careers with OptumInsight. Information and technology have amazing power to transform the Healthcare industry and improve people's lives. This is where it's happening. This is where you'll help solve the problems that have never been solved. We're freeing information so it can be used safely and securely wherever it's needed. We're creating the very best ideas that can most easily be put into action to help our clients improve the quality of care and lower costs for millions. This is where the best and the brightest work together to make positive change a reality. This is the place to do your life's best work.SMDiversity 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: Provider Reimbursement Representative, Teterboro, UnitedHealth Group, Customer Service, Healthcare
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.