Junior Provider Reimbursement Analyst

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data, and resources they need to feel their best.Come make an impact on the communities we serve as we help advance health equity on a global scale. Here, you will find talented peers, comprehensive benefits, a culture guided by diversity and inclusion, career growth opportunities and your life’s best work.SM

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

Summary of Position:

• Responsible for processing capitation (ECap, NICE or CSP Facets – C&S)
• Conducting variance analysis and reporting to support the monthly capitation payments to our Medical Groups, Hospitals and Ancillary providers or vendors
• Analyzing month on month data, identifying, documenting and resolving issues to ensure accurate and timely payments
• Researching variances based on upstream impacts from membership and contracting
• Resolution of issues that may require working with upstream partners such as contracting, membership or product management to identify root causes
• Researching and resolving capitation queries from Network Mgmt., Provider Advocates, Finance, and other constituents

Primary Responsibilities:

• Perform and monitor production jobs, audit queries; run and analyze reports/ variances, ensure payments are processed accurately according to contractual agreements, tight deadlines and defined Capitation Calendar schedule
• Validate variance analysis for preliminary capitation runs to ensure data is correct prior to running monthly capitation
• Review payment disputes to verify correct payments are made and analyze data to determine root cause of errors and recommend system changes, training and process improvements to prevent future errors
• Identify and investigate requests or issues and problem solve, perform process reviews and reconciliations, research conflicting information or identify inaccurate data and work with appropriate department as required. Escalate concerns to Managers and/or upstream partners as required
• Support Contract Managers, Auditors, Network Management, Provider Advocates, Finance and other constituents; by providing research and resolution on capitation questions. Also perform outreaches and follow up timely on queries
• Provide support/mentorship to team members as needed to build on knowledge of Capitation Operational processes, systems, procedures and protocols
• Process manual adjustments as required to ensure the provider is paid timely and accurately per contracts and create backup where required for standard and non-standard monthly adjustments
• Trainer for Provider Advocates, Network Management and Contracted Provider Groups for all regions as well as trainer for new analysts
• Collaborate with IT to ensure fixes are run to update data in the system and monitor outstanding tickets from submission to closure
• Maintain current level of knowledge and apply good judgement to challenge our current processes/procedures and submit recommendations to develop more efficient solutions for the team and higher quality for providers
• Identify and document process improvements, automation opportunities and collaborate with Team and IT on same
• Collaborate with business partners to identify innovative solutions for resolving and decreasing escalated provider issues
• Participate and support applicable projects and system testing, as assigned
• Demonstrate excellent communication written and verbal, excellent time management, problem solving, and organizational skills
• Be a team player, collaborate well, develop and maintain relations with peers, understand individual efforts will combine to achieve overall success

Daily Practices:

• Demonstrate excellent and clear communication both written and verbal
• Quick learner, with solid organizational skills, and an ability to learn and effectively use multiple platforms and systems
• Ability to prioritize and effectively handle multiple priorities and to learn and effectively use multiple program applications and systems quickly and efficiently
• Exhibit Energetic, diplomatic, self-motivated, and high commitment to drive to results in a challenging environment where priorities can change quickly
• Participate and support projects and system testing, as assigned
• Maintain current knowledge of business strategies, protocols, and procedures (e.g., attend training, team meetings, read email communications)
• Ability to work independently, prioritize and organize own work to meet deadlines; and also, as a team player keen to ensure overall departmental success with solid organizational, data analysis and problem-solving skills
• Demonstrate business focus and understanding of our cultural values, vision, and strategy

Required Qualifications:

• High School Diploma/GED (or higher)
• 2+ years of financial analysis, accounting or accounts payable experience
• Intermediate level of proficiency in Microsoft Excel (pivot tables and formulas)
• Basic level of proficiency in Microsoft Access (SQL)

Preferred Qualifications:

• 2+ years of healthcare experience
• Ability to create and conduct effective presentations
• Experience in any of the following platforms: ECap, NICE or CSP Facets

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

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.

#RPO #Green