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UnitedHealth Group Provider Reimbursement Specialist, OptumCare Nevada - Las Vegas, NV in Las Vegas, Nevada

The more you do, the more you learn. And as you learn, you find new doors opening that challenge you to bring your best. This specialist role with UnitedHealth Group will call on your knowledge, your energy and your commitment to making health care work more effectively for more people. We're driving ever higher levels of sophistication in how provider networks are composed and compensated. You'll be part of a team that's out to assist company affiliates with initial deployment and ongoing support of systems and processes that leverage contracted national network rates and policies. Join us and you'll discover the resources, backing and opportunities that you'd expect from a Fortune 6 leader.

Primary Responsibilities:

  • Implement programs designed to ensure proper application of contracted rates and reimbursement policies for company affiliates

  • Perform analysis of claims, pre and post payment, to ensure proper pricing of contracts, reimbursement policies and procedures

  • Review claim disputes to verify correct pricing and analyze claim inquiry data to determine root cause of errors and recommend system changes, training and process improvements to prevent future errors

  • Identify and solve a range of problems within area of expertise

  • Investigate non-standard requests and problems

If you are looking for a challenge, this fast-paced, performance driven team environment is the place to be. You'll be expected to provide analytical expertise and accurate direction on pricing while meeting aggressive production goals.

Required Qualifications:

  • 3+ years of experience working with medical reimbursement methodologies

  • 3+ years of experience in healthcare claims research, analysis and reporting

  • Intermediate proficiency with MS Excel

Preferred Qualifications:

  • Undergraduate degree

  • Ability to create and conduct effective presentations

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: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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.

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

Job Keywords: Managed Care, health care, capitated, claims, analyze, analytics, FFS, medical cost analysis, contract, network, utilization, rates, RBRVS, ASC, APC, DRG, fee schedules, AWP