Pricing Configuration Capability Manager

2 weeks ago

Maitland, 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. 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 delegated entities, 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: 5+ years Facets / NetworX Pricing experience, preferably in provider pricing configuration role 5+ years reading and interpreting physician/facility/ancillary contracts and their associated reimbursement methodologies 5+ 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 Revenue Cycle Management experience Experience with UHC Secondary Platforms (CSP Facets / COSMOS) *All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

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