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)
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.
UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.
We are committed to introducing innovative approaches, products and services that can improve personal health and promote healthier populations in local communities. Our core capabilities... in clinical care resources, information and technology uniquely enable us to meet the evolving needs of a changing health care environment as millions more Americans enter a structured system of health benefits and we help build a stronger, higher quality health system that is sustainable for the long term.
We serve our clients and consumers through two distinct platforms:
?UnitedHealthcare, which provides health care coverage and benefits services.
?Optum, which provides information and technology-enabled health services.