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View Full Version : Medicaid Reimbursement Specialist (MN)
cwoods333
04-03-2011, 06:33 AM
Here is the webpage link: Medicaid Reimbursement Specialist--Telecommute Job in , Minnesota from InsuranceJobs.com at UnitedHealth Group - Information Technology/I.T. (http://jobs.insurancejobs.com/c/job.cfm?site_id=643&jb=7811541&utm_source=Indeed&utm_medium=organic&utm_campaign=Indeed)
Job ID: 7811541
Position Title: Medicaid Reimbursement Specialist--Telecommute
Company Name: UnitedHealth Group
Location(s): Minnesota, United States
Posted: March 31, 2011
Job Function: Information
Job is Full time.
Job Description
The Medicaid Reimbursement Specialist is responsible for developing programs, policies and strategies to ensure that Medicaid non participating facility provider rates and reimbursement policies are applied accurately for company affiliates. Medicaid Reimbursement Specialists will analyze claims, pre and post payment, to ensure system configuration, rates and reimbursement policies and procedures are priced accurately; review claim disputes to verify correct pricing and analyze claim inquiry data to determine root cause of errors; recommend system changes, training and process improvements to prevent future errors; work with both internal and external customers to identify and resolve complex problems; assist company affiliates with initial deployment and ongoing support of systems and processes to leverage Medicaid State specific facility methodologies rates and policies. Other responsibilities include monitoring of State web sites for updates to facility methodologies and fee sources then communicating applicable changes to internal and external customers. In this role you will be expected to:
- Use pertinent data and facts to identify and solve a range of problems within area of expertise
- Work exclusively within a specific knowledge area
- Prioritize and organize own work to meet
- Research and develop programs, policies and strategies to ensure that Medicaid facility non participating provider methodologies, rates and reimbursement policies are applied accurately for company affiliates
- Analyze claims, pre and post payment, to ensure Medicaid facility non participating state rates and reimbursement policies and procedures are priced accurately
- Review claim disputes to verify correct pricing and analyzes claim inquiry data to determine root cause of errors; recommend system changes, training and process improvements to prevent future errors
- Work with both internal and external customers to identify and resolve complex problems
- Assist company affiliates with initial deployment and ongoing support of systems and processes to leverage Medicaid state rates and policies
- Provide explanations and interpretations within area of expertise
Requirements
•3 years experience in either healthcare claims, contracting, reimbursement methodology or any other government regulations experience
•Intermediate proficiency in MS Office (Excel, Word and PowerPoint)
Preferred Skills
•5 years Medicaid reimbursement experience
•5 years facility (i.e. hospital) reimbursement methodology (i.e. AP-DRG, CMS ASC, etc..) knowledge
•3 years experience in project management
•In depth knowledge of United Healthcare claims processing systems (COSMOS, DIAMOND and FACETS)
•Excellent verbal and written skills with the ability to clearly articulate complex or technical information in a clear and concise manner
•Ability to effectively multi task, effectively managing multiple projects and initiatives
•Problem solving skills; the ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action
•Ability to understand and interpret complex information from others including but not limited to reimbursement policies standards
•Ability to effectively deal and communicate to senior management levels
•Ability to facilitate meetings with multiple levels of management
•Ability to develop and maintain policy and procedures or training material documents
•Ability and willingness to work toward team objectives and work well with others
UnitedHealthcare is now UnitedHealthcare Employer & Individual, which is part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system.
When you work with UnitedHealthcare Employer & Individual, what you do matters. It's that simple...and it's that challenging.
In providing consumer-oriented health benefit plans to millions of people, our goal is to create higher quality care, lower costs and greater access to health care. Join us and you will be empowered to achieve new levels of excellence and make a profound and personal impact as you contribute to new innovations in a vital and complex system.
Good Luck!!!
Carlene
Job ID: 7811541
Position Title: Medicaid Reimbursement Specialist--Telecommute
Company Name: UnitedHealth Group
Location(s): Minnesota, United States
Posted: March 31, 2011
Job Function: Information
Job is Full time.
Job Description
The Medicaid Reimbursement Specialist is responsible for developing programs, policies and strategies to ensure that Medicaid non participating facility provider rates and reimbursement policies are applied accurately for company affiliates. Medicaid Reimbursement Specialists will analyze claims, pre and post payment, to ensure system configuration, rates and reimbursement policies and procedures are priced accurately; review claim disputes to verify correct pricing and analyze claim inquiry data to determine root cause of errors; recommend system changes, training and process improvements to prevent future errors; work with both internal and external customers to identify and resolve complex problems; assist company affiliates with initial deployment and ongoing support of systems and processes to leverage Medicaid State specific facility methodologies rates and policies. Other responsibilities include monitoring of State web sites for updates to facility methodologies and fee sources then communicating applicable changes to internal and external customers. In this role you will be expected to:
- Use pertinent data and facts to identify and solve a range of problems within area of expertise
- Work exclusively within a specific knowledge area
- Prioritize and organize own work to meet
- Research and develop programs, policies and strategies to ensure that Medicaid facility non participating provider methodologies, rates and reimbursement policies are applied accurately for company affiliates
- Analyze claims, pre and post payment, to ensure Medicaid facility non participating state rates and reimbursement policies and procedures are priced accurately
- Review claim disputes to verify correct pricing and analyzes claim inquiry data to determine root cause of errors; recommend system changes, training and process improvements to prevent future errors
- Work with both internal and external customers to identify and resolve complex problems
- Assist company affiliates with initial deployment and ongoing support of systems and processes to leverage Medicaid state rates and policies
- Provide explanations and interpretations within area of expertise
Requirements
•3 years experience in either healthcare claims, contracting, reimbursement methodology or any other government regulations experience
•Intermediate proficiency in MS Office (Excel, Word and PowerPoint)
Preferred Skills
•5 years Medicaid reimbursement experience
•5 years facility (i.e. hospital) reimbursement methodology (i.e. AP-DRG, CMS ASC, etc..) knowledge
•3 years experience in project management
•In depth knowledge of United Healthcare claims processing systems (COSMOS, DIAMOND and FACETS)
•Excellent verbal and written skills with the ability to clearly articulate complex or technical information in a clear and concise manner
•Ability to effectively multi task, effectively managing multiple projects and initiatives
•Problem solving skills; the ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action
•Ability to understand and interpret complex information from others including but not limited to reimbursement policies standards
•Ability to effectively deal and communicate to senior management levels
•Ability to facilitate meetings with multiple levels of management
•Ability to develop and maintain policy and procedures or training material documents
•Ability and willingness to work toward team objectives and work well with others
UnitedHealthcare is now UnitedHealthcare Employer & Individual, which is part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system.
When you work with UnitedHealthcare Employer & Individual, what you do matters. It's that simple...and it's that challenging.
In providing consumer-oriented health benefit plans to millions of people, our goal is to create higher quality care, lower costs and greater access to health care. Join us and you will be empowered to achieve new levels of excellence and make a profound and personal impact as you contribute to new innovations in a vital and complex system.
Good Luck!!!
Carlene
