Medicare and Retirement Reimbursement Policy Manager ?????? Telecommute,

United Health Group
Sep 22, 2016
Sep 28, 2016
Employer Type
Direct Employer
Employment Type
Full Time
Position Description:

You'll join a high caliber teamwhere you're assisting, educating, problem-solving and resolving tenuoussituations to the best possible outcomes. Bring your people skills, emotionalstrength and attention to detail. In return we offer the latest tools and mostintensive training program in the industry. Get ready to start doing yourlife's best work.

This position will be a part of avirtual team responsible for developing and maintaining Fraud, Waste andAbuse reimbursement policy editing tosupport the Medicare & Retirement businesssegment. This position will work with other clinical experts to identifytrends, determine regulatory opportunities and constraints and makerecommendations for new and revised reimbursement policies.

Accountability to identify andpursue automated editing solutions while ensuring data integrity, data securityand process optimization. Responsible for driving affordabilityopportunities through CMS methodology research with urgency.

Primary Responsibilities:

* Company thought leader
* Functional SME
* Broad business approach
* Resource to senior leadership
* Develops pioneering approaches to emerging industry trends


* High school diploma or GED
* CPC certification
* 5+ years' experience in CMS methodology, and reimbursement
* Experience researching CMS sourcing requirements
* Working knowledge of following claims platforms (CSP Facets and Cosmos)
* Intermediate proficiency with Microsoft Excel and Word (Excel will be part of work; able to pivot tables, data files, write simply formulas, subtotals, understand and manipulate data. With Word, involves reviewing and tracking changes, add commentaries, work with documents that are heavily formatted and tables embedded in the document).


* Undergraduate degree
* 5+ years of experience in project management
* Knowledge with Fraud, Waste and Abuse recovery concepts
* Working knowledge of professional and facility claim reimbursement
* Experience writing business requirements
* 2+ years of experience with clinical editing tools in support of reimbursements
* Proficiency with One Note and Power Point
* Experience designing and/or maintaining CES editing to support reimbursements
* Experience managing multiple projects and affordability initiatives simultaneously
* Experience with interpreting financial reports and manipulating data
* Experience in policy writing (ex: reimbursements, but not limited to)
* Experience with the NICE claims platform

Soft Skills:

* Excellent business writing skills for provider communications and leadership summarization
* Ability to build cohesive relationships, working across departments
* Exceptional organizational skills
* Excellent presentation skills with the ability to clearly articulate information clearly
* Exceptional customer service skills with the ability to interpret customer needs
* Exceptional innovative thinking skills
* Ability to identify business technical solutions for reimbursements needs
* Exceptional leadership, negotiation and influencing skills

Careers with UnitedHealthcare. Let's talk about opportunity. Start with aFortune 14 organization that's serving more than 85 million people already andbuilding the industry's singular reputation for bold ideas and impeccableexecution. Now, add your energy, your passion for excellence, yournear-obsession with driving change for the better. Get the picture?UnitedHealthcare is serving employers and individuals, states and communities,military families and veterans where ever they're found across the globe. Webring them the resources of an industry leader and a commitment to improvetheir lives that's second to none. This is no small opportunity. It's where youcan do your life's best work.

Diversity creates a healthier atmosphere:UnitedHealth Group is an Equal Employment Opportunity/Affirmative Actionemployer and all qualified applicants will receive consideration for employmentwithout regard to race, color, religion, sex, age, national origin, protectedveteran status, disability status, sexual orientation, gender identity or_expression, marital status, genetic information, or any other characteristicprotected by law.

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

BACH_a33d1a customer reimbursements