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Sr Provider Configuration Analyst, Capitation

3 months ago

Minnetonka, United States UnitedHealth Group Full time

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. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

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

Primary Responsibilities:

  • Participate in system conversions, acting as lead to gather and deliver business requirements, ensuring internal team collaboration to meet project deadlines
  • Collaborate with Pricing Configuration to identify and define quality improvement requirements to ensure flawless pricing execution
  • Promote understanding of provider reimbursement and system architecture to drive cross functional team collaboration
  • Gather and document technical configuration requirements
  • Participate in new market implementation and system conversions to provide business feedback and requirements
  • Perform user acceptance testing and operational readiness for all new programs and program enhancements, ensuring all end-to-end operational impacts assessed, requirements defined, operations documentation completed (e.g., process flows, policies, and procedures), communications delivered, and ongoing operations support established
  • Provide thought leadership in identifying and defining ongoing incremental opportunities
  • Evaluate and continually improve processes to achieve goals that drive best in class pricing outcomes and financial results

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:

  • 3+ years of working with Medicare, Medicaid or Commercial products
  • 3+ years of performing and documenting User Acceptance Test results
  • 3+ years of Facets Pricing experience in provider pricing configuration role
  • 3+ years of Facets / NetworX Pricing experience, preferably in provider pricing configuration role
  • Experience supporting Provider Pricing Configuration
  • Solid knowledge of business end-to-end processes that impact physician/facility/ancillary reimbursement, contract loading and/or auditing

Preferred Qualifications:

  • 2+ years of Facets capitation configuration experience
  • Provider pricing delegation experience
  • Experience with healthcare payer claims systems

*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, Washington, Washington, D.C. 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.