Commercial Reimbursement Policy Manager - US Telecommute

United Health Group
Oct 11, 2016
Oct 19, 2016
Employer Type
Direct Employer
Employment Type
Full Time
Position Description:

Welcome to one of the toughest and most fulfilling ways tohelp people, including yourself. We offer the latest tools, most intensivetraining program in the industry and nearly limitless opportunities foradvancement. Join us and start doing your life's best work.

Our claims operations, including our Professional Reimbursement Policy Manager,are the focal point of handling information about services patients receive andthe way those services get paid. It's complex, detailed work. It's fast pacedchallenge. It's a job that calls on you to be thoughtful, resourceful,team-driven and customer-focused. To put it mildly, there is never a dullmoment.

Positions in this function areresponsible for all related aspects of claim system processes and claim businessrules. Includes claims systems utilization, capacity analyses/planning andreporting Ensures data integrity, data security and process optimization.

Primary Responsibilities:

* Implement claim payment processes that meet regulatory requirements and claim business rules.
* Conduct claims systems utilization, capacity analysis/planning and reporting, and claims-related business and systems analysis.
* Ensure data integrity, data security and process optimization.
* Serve as our internal Regulatory Affairs' point of contact
* Partner with functional area leaders and SMEs to determine impact and solutions
* Implement Claim ops solutions to meet regulatory requirements
* Lead Claim Ops market conduct or financial exam activity, corrective action plans responses and restitution projects
* Remediate gaps in existing production processes that do not meet regulatory requirements
* The candidate is responsible for the overall strategic and tactical activities related to the support of UnitedHealthcare's professional reimbursement policies and promote transparency and affordability initiatives.
* The individual will have demonstrated ability to work across multifunctional teams to assure that the reimbursement policies are compliant with relevant regulations, are as consistent as possible across all segments of UHG, and are third party sourced in support of UHN contract language.
* Reviews the work of others.
* Develops innovative approaches.
* Sought out as expert.
* Serves as a leader/ mentor.


* High School Diploma/GED
* Certified coder via AHIMA or AAPC strongly or an RN
* Knowledge of physician coding methodologies including CPT, HCPCS, and ICD-10
* 3+ years of healthcare professional claims processing or experience in fraud, waste and abusive billing practices
* 2+ years SME/Team Lead experience working with cross functional teams
* Knowledge of State and Fed regulations and CMS reimbursement policies for professional claims
* Experience with Windows applications MS Office - Powerpoint-Creating/Managing Presentations, Excel- Creating/Updating spreadsheets, formulas, and Word- Creating/Updating documents
* 2+ years with data analysis
* Experience leading and facilitating virtual meetings
* Knowledge of iCES and UNET claims processing


* Associates degree or higher
* 2+ years of Project Management experience
* Physician contracting experience
* Familiarity with the LEAN process and leading process improvements
* Experience using Sharepoint

Soft Skills:

* Excellent verbal and written communication/presentation skills required

Take the next step, online at:

Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 14organization that's serving more than 85 million people already and buildingthe industry's singular reputation for bold ideas and impeccable execution.Now, add your energy, your passion for excellence, your near-obsession withdriving change for the better. Get the picture? UnitedHealthcare is servingemployers and individuals, states and communities, military families andveterans where ever they're found across the globe. We bring them the resourcesof an industry leader and a commitment to improve their lives that's second tonone. This is no small opportunity. It's where you can do your life's bestwork.SM

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.

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