UnitedHealth Group is among the most ambitious Fortune 25 companies you'll ever meet. Through our family of businesses, we're working to make the health care system perform better for more people, in more ways than ever.
Simply put, we think the entire system can be greater than it's ever been. And that drives us to work harder, aim higher, and expect more from one another.
Here, you'll be empowered to make an immediate impact for millions of others. And you'll achieve more than you ever expected. How does that fit with your plans?
Provider Install Administrator-314082
UnitedHealth Group is an innovative leader in the health and well-being industry, serving more than 55 million Americans. Through our family of companies, we contribute outstanding clinical insight with consumer-friendly services and advanced technology to help people achieve optimal health.
Description AmeriChoice is part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system.
If you're ready to help make health care work better for more people, you can make a historic impact on the future of health care at AmeriChoice.
We contract with states and other government agencies to provide care for over two million individuals. Working with physicians and other care providers, we ensure that our members obtain the care they need with a coordinated approach.
This enables us to break down barriers, which makes health care easier for our customers to manage. That takes a lot of time. It takes a lot of good ideas. Most of all - it takes an entire team of talent. Individuals with the tenacity and the dedication to make things work better for millions of people all over our country.
Function Description:
Positions in this function are responsible for reviewing contract terms and payment methodologies on provider contracts to load contract terms and pricing into the Diamond platform for Americhoice business. This position includes reviewing and resolving provider pended claims and appeals as they relate to pricing or provider contract, analyzing contract terms to assess the best method for configuring the contract terms into Diamond. Position involves use of various tools such as Lotus Dbase, Team Track and Excel. General Profile:Main accountability to lead and coordinate PCM team activities and tasks as related to configuration options and/or business processes and projects.Reads, interprets and perform configuration duties into Diamond.Provides high level technical advice and solutions for configuration into Diamond and report generation and analysis.Interacts with key business partners, including, but not limited to: Claims Operations, IT, Project Management, Health Plan Operations, Network Management.
Job Scope and Leveling Guidelines:
- Reviews, interprets, and loads provider contracts into the Diamond claims payment platform to support AmeriChoice business.
- Provides high level configuration analysis and approach to ensure contract load into Diamond per contract pricing language.
- Develop, analyze, and monitor new, routine, and ad hoc reports using standard database tools.
- Evaluate, interpret and analyze data, configuration options, and/or business processes.
- Collect, analyze and document business requirements for cross functional projects
- Lead and coordinate configuration teams in cross functional project and achieve timely and accurate deliveries.
- Works with team members to provide configuration guidance, training and technical direction.
- Works with other departments to clarify project/contract intent and payment methodologies.
- Participates in work groups to provide reporting and analysis support, as needed.
- Must be able to communicate effectively with colleagues and business partners.
- Must have working knowledge in claim research and contract loading.
- Applies working knowledge in medical/claim coding to ensure system configuration adheres to Medicare, Medicaid, and other federal/state regulations.
- Able to comprehend and apply industry payment methodologies to configuration and claims research.
- Perform other duties as assigned by department management.
You can be a part of this team. You can put your skills and talents to work in an effort that is seriously shaping the way health care services are delivered. Qualifications
- Demonstrated experience interpreting institutional, ancillary, and professional contracts and fee schedules.
- Strong knowledge of health care benefit principles and medical terminology.
- Strong analytic skills, including the ability to perform root cause analysis and troubleshoot system configuration issues.
- Strong oral and written communication skills; ability to convey ideas, problems, and issues to both business and system audiences
- Demonstrated knowledge of claims coding and payment principles and contract configuration.
- Proficient problem solving, interviewing, and analytical skills; ability to analyze and comprehend business/system processes
- Minimum 3-5 years direct experience with healthcare professional and institutional claims.
- Medicaid and/or Medicare experience is preferred.
- Accustomed to fast paced environment, where timeliness and multi-tasking is required.
- Experience working in a project-driven environment.
- MS Office skills, especially Outlook, Excel, Word; experience with MS Access and SQL a plus.
- Excellent written and oral communication skills.
- Ability to work independently.
- Ability to understand and synthesize information/processes clearly and concisely.
Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.
Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V. UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. |
