Here, your performance, your ideas, your unique analysis will combine with a rich assortment of contributors to understand and shape the health care system. At UnitedHealth Group, you'll work with a team that has the creativity and passion to help build new health care solutions that meet emerging market needs. You'll get the opportunity to work with an elite team that goes beyond the usual analysis, they dig deeper knowing our goal is nothing short of transforming health care. This is a challenging role that creates an opportunity to grow and develop while doing your life's best work.(sm) Positions in this function are responsible for the setup and maintenance of MedSeries 4 Reimbursement module and ensure the integrity of net revenue. Primary Responsibilities:Ensure appropriate government reimbursement, to include, but not limited to, variance and discrepancy analysis, yearly Medicare reimbursement factors review, Medicare Disproportionate Share reimbursement, Medicaid supplemental payments, as well as also other government payment methodologies that have reimbursement implications Code and maintain Managed Care contracts in Med Series 4 _Reimbursement model including the maintenance and update of CPT/ASC/APC/RVU/CMG /IFP/DRG tables, and AR/Case Mix description file, Development and execution of validation plans for coded contract Development and production of managed care scorecards to demonstration validation and payment accuracy Development and production of Payer Scorecard include but limit to A/R, payment and denial trends Hold JOC (Join Operating Committee) with payers to resolve denial trends and/or billing issues to improve cash collection and reduce AR EHR implementation – Build the reimbursement module from the ground up for facilities going through EHR transformation Responsibilities include but not limited to payer and plan code table crosswalk from legacy system to EHR standard, build of carrier and plan code, code reimbursement for both government and managed care payers, set up the initial CPT/ASC/APC /RVU/CMG/FP/DRG tables and AR/Case Mix description file Perform month end reimbursement review on high dollars account with CFOs and Finance, as part of month close process Perform reviews, research and other duties independently or as requested by the Senior Director, VP, CFO and Clients Development and execution of reimbursement related test plans for each system up-grade. Collaborate with IT department to fix any issue that causes error in reimbursement calculation Coordinate with other departments with process improvement project
Required Qualifications:Bachelor's degree or HS Diploma/GED plus 5+ years direct hospital managed care analysis or hospital managed care collections experience 5+ years of experience with hospital reimbursement methodologies 5+ years of experience with hospital collections or claims adjudication Ability to organize and prioritize activities with specific attention to details and higher level strategies, including effective time management skills Advance knowledge in Microsoft Office, Outlook, Excel, Word, PowerPoint, Visio, One Note, SharePointPreferred Qualifications:Experience with automated Expected Reimbursement or Contract Management software systems Experience writing automated scripts. Knowledge of legal and regulatory requirements associated with fee-for-service and managed care risk contracting for professional services to commercial, Medi-Cal and Medicare Advantage populations Knowledge to design compensation methodologies, calculate and evaluate compensation rates, and project the effect on revenues and expensesCareers with Optum360. At Optum360, we're on the forefront of health care innovation. With health care costs and compliance pressures increasing every day, our employees are committed to making the financial side more efficient, transferable and sustainable for everyone. We're part of the Optum and UnitedHealth Group family of companies, making us part of a global effort to improve lives through better health care. In other words, it's a great time to be part of the Optum360 team. Take a closer look now and discover why a career here could be the start to 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: managed care analysis, collections, reimbursements, contract management, Rancho Cordova, CA
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.