Employer & Individual Reimbursement Policy Manager

This position is National Remote. You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. 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 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.

The Employer & Individual Reimbursement Policy Manager is an Individual contributor role part of our Reimbursement Policy team. As a Payment Policy Creation Manager Reimbursement Policy Manager, you will be empowered to develop and maintain UnitedHealthcare policies, cultivate new project initiatives, monitor and research third party sources to ensure UnitedHealthcare’s alignment, ensure implementation of coding and edit updates, and identify potential reimbursement opportunities.

This position is full time. Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00am - 5:00pm. It may be necessary, given the business need, to work occasional overtime. 

We offer 4 weeks of on-the-job training. The hours of training will be aligned with your schedule.

    

Primary Responsibilities:

• Manage E&I and IFP professional and facility reimbursement policies.
• Interfacing with other Reimbursement Policy managers to maintain and support reimbursement policies for UHC and ensure accurate and timely implementation of coding and edit updates.
• Project Management which includes completing multiple phases as part of reimbursement policy creation and implementation including documentation creation, presentations to large groups, and writing business requirement documents.
• Analyzing and manipulating large volumes of data.
• Providing coding and reimbursement policy expertise to UHC departments.
• Ensuring claims are handled accurately in accordance with reimbursement policies.
• Review and analysis of third-party publications and resources regarding reimbursement and coding standards.
• Represent reimbursement policy functions and processes and provide subject matter expertise on any reimbursement policy related initiatives.
• Create and/or maintain materials owned within the department.
• Demonstrated ability to work across multifunctional teams.
• Consistently drive affordability initiatives impacting multiple business segments.
• Develop innovative approaches that support correct coding and accurate claims editing associated with reimbursement policies.

     

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear directions 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
• Coding Certification through AAPC (Ex: CPC, COC, CIC) or an AHIMA certification.  
• Must be 18 years or older 
• Understanding of Facility and Professional Reimbursement policies.
• Knowledge of coding methodologies including but not limited to: CPT, HCPCS, ICD-10, and Revenue Codes.
• Knowledge and experience with CMS (Centers for Medicare and Medicaid Services) manuals and NPFS (National Physician Fee Schedule)
• Experience with editing tools (iCES and/or CES) in support of professional and facility reimbursement policies.
• Experience in one or more of the following platforms/applications -UNET, USP/CIRRUS, and/or Facets.
• Intermediate level of proficiency with PC based software programs including Microsoft Word, Microsoft Excel, and Microsoft Outlook.
• Ability to work full time. Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00am - 5:00pm. It may be necessary, given the business need, to work occasional overtime.

      

Preferred Qualifications:

• Experience with Claims Processing.
• Experience leading and facilitating virtual meetings.
• Experience with Project Management.
• Ability to effectively collaborate with a variety of cross-functional teams and be able to create strong working relationships with both technical and business partners.
• Professional CPC or equivalent Certification, Facility COC/CIC Certification, or equivalent certification through AHIMA 
• Experience with interpreting and summarizing claims data.

     

Telecommute Requirements:

• Required to have a dedicated work area established that is separated from other living areas and provides information privacy
• Ability to keep all company sensitive documents secure (if applicable)
• Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service

      

Soft Skills:

• Must be able to communicate effectively including clear and concise verbal and written communication.
• Must be able to work in a fast-paced team-oriented environment.
• Must be able to perform most tasks with minimal supervision in a virtual environment
• Exceptional organizational skills.
• Ability to prioritize daily work including managing and tracking multiple projects simultaneously

     

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy  

    

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. 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. The salary for this role will range from $72,800 - $130,000 annually based on full-time employment. We comply with all minimum wage laws as applicable.

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.

      

             

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

      

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.
 

Job Details
Job: Claim Business Process
Primary Location: US-TX-Dallas
Other Locations: US-CT-Hartford, US-MN-Minneapolis, US-AZ-Phoenix, US-FL-Tampa
Organization: Ops Payer Payment Integrity
Schedule: Full-time