This position is for a Provider Reimbursement Representative that supports network and pharmacy benefits operations within UnitedHealthcare StudentResources. Chief responsibilities of this position include activities associated with developing programs, policies and strategies to ensure that contracted rates and reimbursement policies are applied accurately for company affiliates. The individual will be expected to work with both internal and external business customers, analyze claims, pre and post payment, ensure contracts and reimbursement policies and procedures are applied 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; resolve complex problems; assist company affiliates with initial deployment and ongoing support of systems and processes to leverage national network rates and policies. Other responsibilities may include involvement with fee schedule and contract template maintenance, designing and maintaining standard operational material (SOP) in the form of procedures, job aids, decision trees, etc.
The candidate for this position shold be self-motivated, able to work independently and within a team environment. Organization and detailed project management skills are integral to success in this role.
- Assist with programs designed to ensure proper prioritization of the network for each unique policy
- Build client relationships and serve as outward-facing primary point of contact
- Conduct and manage outcomes of various projects that includes analyzing, reviewing, forecasting, trending, and presenting information
- Coordinate and collaborate with team members and management
- Resolve customer satisfaction issues through pre and post payment claim analysis, contract and reimbursement policy reviews
- Review disputes and analyze data to determine next steps and execute
- Recommend system changes, training, and process improvements to prevent future errors
- Supports initial contract admin and client service in clarifying requirements, ensuring credentialing, and execution of contracts and fulfillment of obligations
- Validate deliverables for accuracy, readability, and usability for Sales RFP process
- Work with less structured, more complex issues in a fast-paced environment
You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
- High school diploma or equivalent work experience
- 1+ years’ experience working with reimbursement methodologies
- 1+ years’ experience in claims research, analysis and reporting
- Full COVID-19 vaccination is an essential requirement of this role. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination prior to employment to ensure compliance.
- Undergraduate degree in Communication, English, or Business Administration
- Certification in Technical Writing
- Intermediate proficiency with MS Office (Excel, Word and PowerPoint)
- Strong research and analytical skills
UnitedHealth Group requires all new hires and employees to report their COVID-19 vaccination status.
Careers at UnitedHealthcare Employer & Individual. We all want to make a difference with the work we do. Sometimes we're presented with an opportunity to make a difference on a scale we couldn't imagine. Here, you get that opportunity every day. As a member of one of our elite teams, you'll provide the ideas and solutions that help nearly 25 million customers live healthier lives. You'll help write the next chapter in the history of health care. And you'll find a wealth of open doors and career paths that will take you as far as you want to go. Go further. This is 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: #RPO, Richardson, Texas, TX, hiring immediately