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.
Optum, part of the UnitedHealth Group family of companies, is looking for a Regulatory Affairs Consultant - Remote. This person will serve as a subject matter expert in the area of Medicare, Medicaid and Commercial reimbursement, assisting others in the design, development, and support of software to edit claims and calculate payment.
The leader in prospective payment system (PPS) reimbursement, Optum® EASYGroup™ keeps up with ever-changing PPS rules, content, and ongoing regulations for our clients. EASYGroup™ creates editing, grouping and reimbursement software used nationally by Medicaid Managed Care Organizations, Medicare Advantage Payers, and hospital providers.
EASYGroup is a portable software library offering more than 50 federal, state and payer-specific prospective payment systems — the most comprehensive PPS solution available today. Its sophisticated technology allows hospital and physician contracts related to federal and state reimbursement to be effectively maintained, updated, and negotiated.
You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities
- Track and analyze all new and existing regulatory requirements pertaining to Medicare, Medicaid, and Commercial reimbursement, based on assigned products
- Prepare summaries and analysis of the relevant regulatory updates, comparisons to existing or proposed regulations and detailed descriptions of the operational requirements and affected products
- Enter the updates and changes to the regulations and rules, along with any data elements into a data base used to track the updates
- Maintain and update all applicable software on your computer
- Maintain a working knowledge of the requirements for assigned products
- Work independently to analyze and manage regulatory content for assigned products
- Complete testing of software for Medicaid States/Product releases
- Correspond with various entities, such as Medicare, TRICARE, and state agency contacts. Ensure that the responses are sent to the appropriate team(s) and that follow ups are sent as needed
- Assist clients with various regulatory and product inquiries, via Salesforce tickets, client meetings, and email exchange
- Meet with key accounts, business partners, and potential customers, explaining the regulatory environment, discussing their requirements, and explaining how we can meet their requirements with our products and services
- Help determine product direction for existing products and services, and design new products and services, based on national and regional prospective payment initiatives
- Evaluate new health care programs or benefits from Medicare, Medicaid, and commercial payers
- Work with product managers to identify areas of product growth based on industry trends
- Provide assistance, leadership and mentoring for other Regulatory and Optum staff
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 health care, managed care, and/or health insurance
- 5+ years of experience in a health care regulatory environment
- 3+ years of project management experience, including experience simultaneously managing multiple projects
- 3+ years of experience with state, HIPPA, and other federal privacy laws
- 2+ years of experience working with Federal or State Programs
- Experience with Medicare, Medicaid, TRICARE reimbursement methodology
- Experience building relationships across business groups internally and outside the organization (regulatory agencies)
Preferred Qualifications
- Experience with the Optum PPS Software
- Experience with the reimbursement methodology for the various Optum PPS software products
- Experience maintaining and updating work laptop with all applicable Optum software
- All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy.
The salary range for this role is $89,800 to $176,700 annually based on full-time employment. 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.
