- Read and interpret complex professional provider contracts
- Conduct Audits in Partnership with the Internal Teams
- Create reports and analyses using Facets data to validate pre and post configuration changes made by self or others
- Conducts Configuration Analysis (by reviewing configuration set-up and identifying root cause of findings)
- Collaborate with Claim Ops to Validate Accuracy of Claims Payments to Capitated Providers
- Collaborate with Eligibility to Validate Accuracy of Provider Empanelment
- Identify Process Improvement Opportunities (to improve accuracy and timeliness)
- Assists with Internal Quality Control Points and Unit Testing
- Serves as SME to assist Provider Configuration Team
- Participates in Configuration Requirement Gatherings for New Business and/or Processes
- Monitor Fee Schedule Team Tasks and process requests as submitted
- Collaborate with delegated business partners to identify and receive fee schedule pricing information
- Execute SQL stored procedures to request new fee schedules
- Participate in the resolution of fee schedule pricing issues and end-to-end audit requests
- High school diploma or GED
- Provider Capitation experience
- Network Management Contracting to include knowledge of business processes that impact capitation contract loading and auditing
- Intermediate level of proficiency with Microsoft Word / Excel / Outlook / SharePoint
- Proficiency with Physician reimbursement strategies, including fee schedule and global capitation
- Proven self-directed individual with a proven track record of solid organizational skills and ability to adapt quickly to change
- Proven solid communication skills to clearly and concisely translate complex or technical information for diverse internal audiences
- Proven solid customer focus with proven ability to anticipate, understand, and meet the needs of internal and external customers
- Proven ability to manage productivity and efficiency in order to visualize and achieve set goals for delivery of contracts for installation
- Proven ability to conduct data analysis using MS Access or SQL to support business decisions related to capitation setup and pricing configuration
- Facets configuration experience with capitation
- Facets experience in Provider Configuration
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Provider Configuration Analyst - Minnetonka, United States - Optum
Description
For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together.
The Facets Provider Pricing Capitation Analyst will be responsible for reading, interpreting, and building contracts for contracted providers who are reimbursed according to a capitation method. Capitation analyst will execute programs to evaluate preliminary month-end reporting statistics and make any adjustments required to properly administer contractual requirements. Analyst is also responsible for performing end-to-end fee schedule and pricing maintenance processes. May also be accountable for installing provider contracts or helping troubleshot pricing concerns related to fee schedule reimbursement.
You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:
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:
Preferred Qualifications:
*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Rhode Island, or Washington Residents Only: The hourly range for this role is $33.75 to $66.25 per hour. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. 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.
Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.
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.
