Health Plan Reimbursement Policy Manager

This position is Remote in Mainland USA. You will have the flexibility to work remotely* as you take on some tough challenges.
Optum Insight is improving the flow of health data and information to create a more connected system. We remove friction and drive alignment between care providers and payers, and ultimately consumers. Our deep expertise in the industry and innovative technology empower us to help organizations reduce costs while improving risk management, quality and revenue growth. Ready to help us deliver results that improve lives? Join us to start Caring. Connecting. Growing together.
Our claims operations, including our Senior Claims Business Process Consultants, are the focal point of handling information about services patients receive and the way those services get paid. It's complex, detailed work. It's fast paced challenge. It's a job that calls on you to be thoughtful, resourceful, team-driven and customer-focused. To put it mildly, there is never a dull moment.
This position is full-time (40 hours/week) Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8am - 5pm EST. It may be necessary, given the business need, to work occasional overtime.
We offer 2 weeks of on-the-job training. The hours of training will be aligned with your schedule.
Primary Responsibilities:

• Coordinate with Health Plans to implement processes that ensure adherence to all applicable regulatory standards
• Implement claim payment processes that meet regulatory requirements and claim business rules
• Conduct claims systems utilization, capacity analysis/planning and reporting, and claims-related business and systems analysis
• Ensure data integrity, data security and process optimization
• Serve as our internal Regulatory Affairs' point of contact
• Partner with functional area leaders and SMEs to determine impact and solution
• Implement Claim ops solutions to meet regulatory requirements
• Remediate gaps in existing production processes that do not meet regulatory requirements

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
• Must be 18 years of age or older
• 5+ years of Medical/Healthcare job experience
• 1+ years of Medical/Healthcare claims processing experience
• 2+ years of Supervisory or Team Lead experience
• Intermediate experience with computer and Windows PC applications
• Advanced level of Microsoft Excel (creating spreadsheets, v-lookups, pivot tables)
• Ability to work full-time (40 hours/week) Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8am - 5pm EST. It may be necessary, given the business need, to work occasional overtime

Preferred Qualifications:

• Certified coder via AHIMA or AAPC (credentials: CPC, COC, CIC, CRC, CASCC, CANPC, CCC, CCA, CPDC, CEDC, CEMC, CFPC, CGIC, CIMC, CGSC, CHONC, CIRCC, COBGC, COPC, COSC, CPEDC, CRHC, CUC, CCS, RN, BSN, AND, MA, LPN, PT or PTA)
• Knowledge of FACETS claims processing platforms
• Knowledge of reimbursement policies
• Knowledge of State and Federal regulations that govern commercial health insurance claim payment

Telecommuting Requirements:

• Reside within Mainland USA
• Ability to keep all company sensitive documents secure (if applicable)
• Required to have a dedicated work area established that is separated from other living areas and provides information privacy
• Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $72,800 - $130,000 annually based on full-time employment. We comply with all minimum wage laws as applicable.
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.
UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.