Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start
Caring. Connecting. Growing together.
You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities - PPS/AMS (Prospective Payment Systems / Application Management Support) Client Support:
- Ensures successful installation, implementation, and configuration
- Apply analytical / quantitative approach to problem solving
- Knows how to obtain and use data, and comfortable with statistical concepts
- Utilize communication skills to influence and negotiate
- Utilize one’s solid interpersonal skills to work with all levels of management across all functional areas, as well as business partners through internal entities
- Work within client ticketing system to track escalated issues, input new issues or answer issues sent in by other teams
- Communicate any responses back to client
- Implement changes as needed and outlined in contract
- Work directly with Optum colleagues and customers to determine and document Client PPS payment system methodology education needs
- Work directly with Optum colleagues and clients to determine and document Client requirements for Optum PPS product training
- Works directly with customers to define other project requirements, provide assistance to answer questions related to project results
- Assist as needed with other Reimbursement Solutions projects
- Engage with dedicated clients either VPN or Remote, WebEx to apply updates or Troubleshoot issues using documentation from Regulatory
- Support Optum Business Partners with questions around integration
- Compile Documentation: Processes and Procedures (including but not limited to Clients specific tracking, network configuration, rules of engagement)
Flexible work hours, part of a great team that works well together, & growth opportunities.
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
- 5+ years of experience working in a healthcare data or regulatory environment
- 3+ years of experience pricing Medicare hospital facility claims (inpatient and outpatient)
- 3+ years with PPS (Prospective Payment Systems), such as DRG, APC, OCE, ESRD, CAH, CMG, RUG, or RBRV
- 3+ years of experience with Facility/Hospital claims reimbursement, such as Medicare, Medicaid, or Commercial
- Experience with EasyGroup, RateManager, WebStrat, and/or PSI (Payment System Interface)
- Experience documenting client’s operational and technical workflow
- Experience breaking down information and developing solutions
- Exposure to healthcare claims data, including UB04 and/or HCFA1500 claim content
- Proficiency with MS Office, including Word, Excel, and PowerPoint
Preferred Qualifications
- Experience with .Net or IIS (Internet Information Services)
- Experience configuring and customizing software solutions
- Health Plan experience, specifically in facility contract configuration, claims or IT
- SQL experience
- Claims system knowledge, such as Cognizant Facets, Networx Pricer, QNXT, Health Rules Payer, IKA Claims, Burgess Systems, Epic Tapestry, or 3M
- MS Visio proficiency
- All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy
California, Colorado, Connecticut, Hawaii, Maryland, Nevada, New Jersey, New York, Rhode Island, Washington, Washington, D.C. Residents Only: The salary range for this role is $70,200 to $137,800 annually. 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.
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.
