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Must Reside in NY State
If you are located in the state of New York, you will have the flexibility to work remotely* as you take on some tough challenges.
Primary Responsibilities
Educate contracted providers and internal Provider Relations and Network Claims Liaison staff (i.e., professional and institutional) regarding NY Medicaid billing requirements and methodologies which includes appropriate claims submission requirements, coding updates, electronic claims transactions and electronic fund transfer, and available resources such as provider manuals, website, fee schedules, etc.
- Serve as point of contact for centralized service units when local market information or action is required to resolve/manage service issues
- Promptly escalate and initiate expedited resolution actions within the Service Model, monitor resolution progress, and establish regular communication with the provider until complete resolution achieved
- Reinforce Network Management provider education activities re: navigation of service resolution paths
- Facilitate management of complex service and/or service issues in conjunction with the Market Lead, including analysis of service failures to determine course of action to resolve the service issue and ensure service process and/or performance gaps are documented and addressed
- Collate, evaluate, and report on service issues/risks/trends to support Network Management contract negotiations and relationship mgmt for core and strategic providers
- Ongoing efforts to identify and resolve global root cause drivers of claims/service issues
- Identify trends and guides the development and implementation of strategies to improve provider satisfaction. Frequently communicate (i.e.: telephonic and on-site) with providers to assure the effective exchange of information and gain feedback regarding the extent to which providers are informed about appropriate claims submission practices
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 of experience in a managed health care environment working in or with the insurance side of the business
- 2 + years of experience with NY Medicaid billing and methodology
- Experience working with NY providers
- Claims and billing experience (examples of experience include: Claims processor, Claims auditor, Claims examiner, Certified Coder, etc.)
- Experience with provider relations issue resolution and conflict management skills
- Proven ability to meet performance metrics (turn-around time, issue resolution, root cause analysis)
- Proven ability to drive resolution
- Proven ability to work independently with minimum supervision
- Proven solid verbal and written communication skills
- Reside in NY
- Ability to travel 25% of the time within NY State
- All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy
New York Residents Only: The salary range for this role is $70,200 to $137,800 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.
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 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.
OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
