Health Plan Reimbursement Policy Manager

UnitedHealth Group • Minneapolis, MN

1d • Remote

About The Position

This position is Remote in Mainland USA. You will have the flexibility to work remotely as you take on some tough challenges.
Optum Insight is improving the flow of health data and information to create a more connected system. We remove friction and drive alignment between care providers and payers, and ultimately consumers. Our deep expertise in the industry and innovative technology empower us to help organizations reduce costs while improving risk management, quality and revenue growth. Ready to help us deliver results that improve lives? Join us to start Caring. Connecting. Growing together.
Our claims operations, including our Senior Claims Business Process Consultants, are the focal point of handling information about services patients receive and the way those services get paid. It's complex, detailed work. It's fast paced challenge. It's a job that calls on you to be thoughtful, resourceful, team-driven and customer-focused. To put it mildly, there is never a dull moment.
This position is full-time (40 hours/week) Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8am - 5pm EST. It may be necessary, given the business need, to work occasional overtime.
We offer 2 weeks of on-the-job training. The hours of training will be aligned with your schedule.
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.

Requirements

• High School Diploma / GED
• Must be 18 years of age or older
• 5+ years of Medical/Healthcare job experience
• 1+ years of Medical/Healthcare claims processing experience
• 2+ years of Supervisory or Team Lead experience
• Intermediate experience with computer and Windows PC applications
• Advanced level of Microsoft Excel (creating spreadsheets, v-lookups, pivot tables)
• Ability to work full-time (40 hours/week) Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8am - 5pm EST. It may be necessary, given the business need, to work occasional overtime

Nice To Haves

• Certified coder via AHIMA or AAPC (credentials: CPC, COC, CIC, CRC, CASCC, CANPC, CCC, CCA, CPDC, CEDC, CEMC, CFPC, CGIC, CIMC, CGSC, CHONC, CIRCC, COBGC, COPC, COSC, CPEDC, CRHC, CUC, CCS, RN, BSN, AND, MA, LPN, PT or PTA)
• Knowledge of FACETS claims processing platforms
• Knowledge of reimbursement policies
• Knowledge of State and Federal regulations that govern commercial health insurance claim payment
• Reside within Mainland USA
• Ability to keep all company sensitive documents secure (if applicable)
• Required to have a dedicated work area established that is separated from other living areas and provides information privacy
• Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service
• All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

Responsibilities

• Coordinate with Health Plans to implement processes that ensure adherence to all applicable regulatory standards
• Implement claim payment processes that meet regulatory requirements and claim business rules
• Conduct claims systems utilization, capacity analysis/planning and reporting, and claims-related business and systems analysis
• Ensure data integrity, data security and process optimization
• Serve as our internal Regulatory Affairs' point of contact
• Partner with functional area leaders and SMEs to determine impact and solution
• Implement Claim ops solutions to meet regulatory requirements
• Remediate gaps in existing production processes that do not meet regulatory requirements

Benefits

• In addition to your salary, we offer 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 us, you’ll find a far-reaching choice of benefits and incentives.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED