Position Description: Welcome to one of the toughest and most fulfilling ways to help people, including yourself. We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement. Join us and start doing your life's best work. You'll join a high caliber team where you're assisting, educating, problem-solving and resolving tenuous situations to the best possible outcomes. Bring your people skills, emotional strength and attention to detail. In return, we offer the latest tools and most intensive training program in the industry. Get ready to start doing your life's best work.Positions in this function are responsible for all related aspects of claim system processes and claim business rules. Includes claims systems utilization, capacity analyses / planning and reporting. Includes claims-related business and systems analysis. Ensures data integrity, data security and process optimization. Primary Responsibilities:This position manages all aspects of planning, development, and delivery of the Strategic Operations Support (SOS) team's core goals and supervises the SOS teamDevelops new processes / procedures for UHC STARS initiatives, as it relates to the provider inquiry mailboxAssists the UHC ACE team with developing new edits for COSMOS based on CMS rules and regulations, boost plan savings, and potentially improve STAR ratingsCoordinate, develop, implement and evaluate departmental process designsEstablish ongoing communication of issues and improvement recommendations to share with process owners and senior management throughout the life of assigned projectsWork with management to define risk mitigation action and to resolve process gapsSupervision of the SOS team, which includes:Manages the QA for STARS / HEDIS provider outreach faxes for both the medication adherence and DNSP medication reconciliation projectsManages the Provider email inbox for STARS / HEDIS inquiries, working across multiple departments for potential resolution and record acquisitionDevelops the process and managing quality validation for provider demographic information related to STARS / HEDIS chasesProvider escalation unit - includes actively working escalated cases across various departments to prevent CTMs, Executive Complaints, DOI complaints, Legal issues, Contract Terminations, etc.
Required Qualifications:High School Diploma / GED5+ years of experience working within a Medicare environment2+ years of supervisory experienceMedicare Policy Subject Matter Expert Project Management experienceThe ability to interpret and comprehend CMS regulations, the federal register and legal documents is requiredPreferred Qualifications: Legal writing experience is a plusProvider relations experience is a plusBackground in claims processing and / or appealsSoft Skills: Ability to write clear, professional communications for internal and external contactsAbility to monitor and evaluate ongoing activities and recommend process improvementsExperience in a position requiring excellent written and verbal communication skillsAbility to set work priorities and complete tasks in a timely mannerExperience dealing with conflict, changing work environment, problematic personnel and partners and competing prioritiesSelf-motivated and flexibleExcellent organizational and time management skillsDemonstrated ability to exercise good judgment, initiative, and tact in dealing with providers, vendors, and internal contactsCareers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 6 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can do 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.Keywords: UnitedHealth Group, San Antonio, Manager Business Process, Medicare, Project Management, CMS Regulations
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.