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Pricing Configuration Capability Manager

4 months ago

Maitland, United States UnitedHealth Group Full time

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.

As the Pricing Configuration Capability Manager, you will be vital to our success and drive quality improvements and operating efficiency for provider contract configuration and the providers Optum Care serves who have contracts that are based on Medicare, Medicaid, or Commercial reimbursement requirements. You will join a team of operation leaders and play a vital role in ensuring we consistently meet and exceed market expectations.

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

Primary Responsibilities:

  • Serve as primary pricing source to assess business requirements against Facets / NetworX capabilities; ensure identified limitations are documented and communicated to project leads, IT resources and management
  • Interpret payor contracts to determine division of financial responsibility between payer and plan
  • Serve as pricing expert to critically assess provider contracts that are based on Medicare reimbursement methodology, including Prospective Payment Systems (PPS) for facilities or one or more of Medicare's fee schedules; convert contracts into standard design templates for others to use for configuration purposes
  • Read, interpret, and critically assess provider contracts that are based on Medicaid reimbursement methods; or for contracts that are based solely on commercial pricing methods, to define configuration rules for analysts
  • Assess new contract strategies for existing and new payers to ensure Facets/NetworX system capability can meet pricing requirement; and recommend solutions to minimize manual processes to address system limitations
  • Collaborate with Pricing Configuration Managers / SMEs 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 technical requirements and participate in the documentation of business requirements to facilitate the creation of automated solutions and control reports to monitor and improve standards in pricing operations
  • Participate in new market implementation and system conversions to provide business feedback and requirements
  • Perform user acceptance testing and assigned tasks to enable operational readiness for NetworX system upgrades 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:
  • 4+ years Facets / NetworX Pricing experience, preferably in provider pricing configuration role
  • 4+ years reading and interpreting physician/facility/ancillary contracts and their associated reimbursement methodologies
  • 4+ years working with Medicare, Medicaid, or Commercial products
  • Experience gathering and documenting business requirements and developing workflows
  • Experience executing SQL queries and analyzing reports
  • Solid knowledge of end-to-end business processes that impact physician/facility/ancillary reimbursement, contract loading and/or auditing
Preferred Qualifications:
  • Division of Financial Responsibility Configuration Experience using Facets Assigned Risk Module
  • Capitation Configuration Experience
  • Provider pricing delegation experience
  • Experience with UHC Secondary Platforms (CSP Facets / COSMOS)
  • Revenue Cycle Management experience

*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 salary range for this role is $88,000 to $173,200 annually. 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: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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.

OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.