UnitedHealthcare Hiring for Division of UnitedHealth Group Job at UHC Provider Reimbursement Representative Full Time

UnitedHealthcare is a company that’s on the rise. We’re expanding in multiple directions, across borders and, most of all, in the way we think. Here, innovation isn’t about another gadget, it’s about transforming the health care industry. Ready to make a difference? Make yourself at home with us and start doing your life’s best work.(sm)

The UHC Provider Reimbursement Representative-Escalated Issues Team requires that an employee will review and respond to emails received from UHN Network Managers, UHC Provider Advocates, the Social Media Team and UMR internal employees in regards to UMR processes, procedures and results that are being challenged. These inquiries can range from claim processing challenges and contracted pricing reviews, to questions about UMR plan language, authorizations, penalties, prompt pay and even legal and social media issues. Escalated Issues team members also review inquiries sent from internal UMR departments in relation to UHC provider questions and processes related to contracts. Persons in this position will need to be resourceful and able to work with the various UMR and UHC departments to be able to provide the information to resolve the inquiries, which includes phone calls to providers and UHC representatives. This position is fast paced due to TAT guarantees and candidates will be required to be thorough in their reviews and professional in their replies. Persons in this position need to work in a team environment and be able to organize and prioritize daily work tasks from inquiries received via the UMR-UHC Escalated Issues Email box, which will be the main responsibility for this role. This position will require working with multiple internal UMR and UHC departments as well as external customers and providers to identify and resolve complex issues in a professional and quality focused manner.

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

Primary Responsibilities:

• Review emails received from UHC Network Management to determine issue for UHC contracted providers
• Manage email inventory to ensure emails are reviewed and resolved accurately and meet required turnaround time with proper communication back to the sender, following up regularly as needed
• Escalate within UMR to appropriate departments to assist in review and resolution of UHC Provider issues
• Ensure plan benefits and processing is completely accurate on submitted claim review requests
• Work with UHC Network Management to obtain UHC contract language in regard to Prompt Pay, Medical Necessity, reconsideration requests, overpayments and special processing instructions. Request medical records from providers when claim reach outs have been exhausted
• Review Social Media email submissions for urgent outreach and resolution with the member or the UMR group, including UHSS
• Recommend system changes on provider contracts that appear inaccurate in the NDB (UHC Provider Network Database)
• Educate UHC Network Management and UHC Providers in regard to UMR plan benefits and processes
• Attend meetings with UHC Network Management and UHC Providers to assist on trending and escalated UMR issues
• Call providers as needed for additional information or to assist on a complex claim review and explanation
• Assist with UHC projects and other tasks related to provider relations
• Prioritize and organize own work to meet agreed upon deadlines
• Work with both internal and external customers to identify and resolve complex problems

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:

• High School Diploma/GED (or higher) OR 4+ years of experience with UMR/CPS medical claim processing, workflows, and report review
• 2+ years of experience with UMR/CPS medical claim processing, workflows, and report review
• 2+ years of experience as an employee for UnitedHealth Group
• Intermediate level of proficiency with Microsoft Excel (sort, filter, and entry) and Microsoft Word (work within templates; create, develop, and send correspondence)

Soft skills:

• Strong research and analytical skills
• Ability to operate in a fast paced, goal-oriented production environment
• Ability to independently work on projects, reports and assignments
• Ability to successfully navigate computer systems and software
• Ability to read directions and apply mathematical calculations

Soft Skills:

• Excellent interpersonal skills at both an individual and team level
• Excellent written, verbal, and business communication skills

To protect the health and safety of our workforce, patients, and communities we serve, UnitedHealth Group and its affiliate companies now require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state, and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.

Careers with UnitedHealthcare. Let’s talk about opportunity. Start with a Fortune 5 organization that’s serving more than 85 million people already and building the industry’s singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-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. We bring them the resources of an industry leader and a commitment to improve their lives that’s second to none. This is no small opportunity. It’s where you can do your life’s best work.(sm)

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

Colorado, Connecticut or Nevada Residents Only: The salary range for Colorado residents is $18.17 to $32.26. The salary range for Connecticut / Nevada residents is $20.00 to $35.53. Pay is based on several factors including but not limited to education, work experience, certifications, etc. 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.

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.

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