09/21/2022

Senior PPS Consultant - Telecommute

  • UnitedHealth Group
  • San Jose, CA, 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's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.(sm)

 

No industry is moving faster than health care. And no organization is better positioned to lead health care forward. We need attention to every detail with an eye for the points no one has considered. The rewards for performance are significant. You'll help improve the health of millions. We are looking for an experienced Senior Consultant as an addition to the Optum Payment Integrity Practice in Optum Payer Consulting. Responsibilities require solid understanding healthcare claims data, basic PPS concepts, UB04 and HCFA 1500 claim content, ability to conduct research of varying federal and states Medicaid regulations to determine hospital, ambulatory surgery, and physician provider reimbursement rules. Candidates must also demonstrate excellent data management and data quality skills.

You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

  • Perform PI (Payment Integrity) Data Analytic Support:  Apply analytical/quantitative approach to problem solving
  • Utilize ability to obtain and use data, communication skills to influence and negotiate, and comfortable with statistical concepts
  • Utilize one’s solid interpersonal skills to work with all levels of management across all functional areas, and business partners through internal entities
  • Provider Reimbursement support: Researching, compiling, interpreting, documenting, developing appropriate specifications for testing and deploying custom pricing solutions
  • Work directly with colleagues and customers to determine and document reimbursement or product training and education needs
  • Deliver customer training and education programs
  • Conduct regulatory research to determine revisions/updates to various federal and state Medicaid payment systems and updating the appropriate library of education materials to reflects current rule and regulations
  • Work with customers to define other project requirements, and provide assistance to answer questions related to project outcomes
  • Assist as needed with other claims pricing projects

 

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:        

  • Bachelor’s degree or 2+ years of experience working with EasyGroup, Rate Manager, Web.strat, or PSI software 
  • 5+ years of experience working in a healthcare data or regulatory environment    
  • Working knowledge of PPS (Prospective Payment Systems), such as DRG, APC, OCE, ESRD, CAH, ASC, SNF, HHA, LTC, IPF, IRF, FQHC, Hospice, or Professional claims    
  • Experience pricing Medicare hospital facility claims (inpatient and outpatient)
  • Experience breaking down information and developing solutions    
  • Health plan or payment integrity experience in facility contract configuration, claims operations or IT    
  • Experience documenting clients’ operational and technical workflow    
  • Experience configuring and customizing software solutions    
  • Facility claims reimbursement experience in Medicare, Medicaid, and/or Commercial    
  • Solid knowledge of healthcare claims data, such as UB04 and HCFA 1500 claim content, EDI, and/or 837i/837p  
  • Proven ability to conduct research on varying federal and state Medicaid regulations to determine hospital, ambulatory surgery, and physician provider reimbursement rules    
  • Demonstrated solid skills in data management and data quality   
  • Proficiency with MS Office, including Word, Excel, and PowerPoint 
  • Experience working with MS Visio   
  • Ability to accommodate up to 30% nationwide travel to client sites or Optum sites     
  • 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 

Preferred Qualifications:        

  • Bachelor’s degree
  • Tableau experience      
  • .NET or IIS experience      
  • Optum CES experience    
  • Experience working with EasyGroup, Rate Manager, Web.strat, or PSI software   
  • SQL experience, including writing queries, loading tables, and building output file    
  • Claims system knowledge, such as TriZetto Facets, NetworX Pricer, QNXT, Health Rules Payer, IKA Claims, Burgess Systems, Epic Tapestry, or 3M    

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)

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

Colorado, Connecticut or Nevada Residents Only: The salary range for Colorado residents is $82,100 to $146,900. The salary range for Connecticut/Nevada residents is $90,500 to $161,600. Pay is based on several factors including but not limited to education, work experience, certifications, etc. 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.

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.


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