Reimbursement Policy Manager- San Juan, PR

  • UnitedHealth Group
  • San Juan, PR, United States
Full Time

Job Description

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that is improving the lives of millions. Here, innovation is not about another gadget; it is about making health care data available wherever and whenever people need it, safely and reliably. There is no room for error. If you are looking for a better place to use your passion and your desire to drive change, this is the place to be. It's an opportunity to do your life's best work.(sm)

We’re in search of an Individual contributor to join our Reimbursement Policy team. As a 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.  

Primary Responsibilities:

  • 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
  • Complete multiple phases as part of reimbursement policy creation and implementation including documentation creation, presentations to large groups, 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


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:

  • 1+ years of experience in facility and professional reimbursement policies 
  • Professional CPC/CCS Certification, Facility COC Certification or equivalent experience and a willingness to obtain certification
  • Experience with editing tools (iCES and/or CES) in support of professional and facility reimbursement policies
  • Experience in claims processing
  • Experience in one or more of the following platforms/applications -UNET, USP/CIRRUS
  • Experience leading and facilitating virtual meetings
  • 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)
  • Intermediate level of proficiency with PC based software programs including MS Word, Excel, Outlook
  • Professional English proficiency 
  • Ability to work in a fast-paced team-oriented environment 
  • Ability to perform most tasks with minimal supervision in a virtual environment
  • Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation

To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)

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.

Apply Now