At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities, and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable, and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together.
The UHC Team Provider Reimbursement Representative-Disputes is responsible for applying policies and strategies to ensure that contracted rates and reimbursement policies are applied accurately for company affiliates. Provider Reimbursement Representatives support those who analyze claims, pre and post payment, to ensure contracts and reimbursement policies and procedures are priced 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; work with both internal and external customers to identify and resolve complex problems. Other responsibilities may include involvement with fee schedule and contract updates needed in the NDB by utilizing the .NET CPO tool.
You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:
- Review claims received in the OnBase application to determine outcome of provider disputes regarding pricing/editing
- Manage inventory to ensure claims are repriced accurately and meet required turnaround time
- Perform fee schedule and contract review on assigned claims
- Ensure network contracts and reimbursement policies are applied accurately on affiliated medical disputes
- Recommend system changes on provider contracts that appear inaccurate in the NDB (UHC Provider Network Database)
- Assist with UHC projects and other tasks related to provider relations
- Prioritize and organize own work to meet agreed upon deadlines
- Work with both internal and external customers to identify and resolve complex problems
- Review daily/weekly hold queue inventory
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.
Required Qualifications:
- High School Diploma/GED (or higher) OR 4+ years of experience with applying UHC provider contracted rates for repricing
- 2+ years of experience with applying UHC provider contracted rates for repricing
- 1+ years of experience with NDB contract review, ppoONE, and UMR UHN Team applications
- Intermediate level of proficiency with Microsoft Excel (sort, filter, and data entry)
- Intermediate level of proficiency with Microsoft Word (work within templates)
- Intermediate level of proficiency in iCES, NDB, ppoONE and network contracts
- Ability to read directions and apply mathematical calculations to reprice claims
Soft Skills:
- Strong research and analytical skills
- Strong interpersonal skills at both an individual and team level
- Strong written, verbal and business communication skills
- Ability to operate in a fast paced, goal-oriented production environment
- Ability to independently work on assigned projects, reports, and assignments
- UB pricing experience
- Medical Coding and/or experience in a medical facility
- All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.
California, Colorado, Nevada, Connecticut, New York, New Jersey, Rhode Island, Hawaii, Washington, or Washington D.C Residents Only: The hourly range for California, Colorado, Nevada, Connecticut, New York, New Jersey, Rhode Island, Hawaii, Washington, or Washington D.C residents is $19.47 to $38.08 per hour. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.
Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.
Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.
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.
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