NetworX Provider Reimbursement Configuration SME - Remote - 2211573
At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together.
The NetworX Provider Reimbursement Config SME is responsible for reviewing, interpreting contract language, state requirements and reimbursement policies and document the intent to load information into system. As a key member of PDO Migration & Strategy team, you will embrace the opportunity to use your Facets (Core or NetworX) knowledge while working multiple migration and implementation projects simultaneously. Your ability to shift priorities to meet business requirements will allow you to be a part of a dynamic and growing team.
You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
- NetworX Configuration analyst who can lead and define system requirements associated with Provider Reimbursement, payment systems requirements definition, document, design, testing, training and implementation support
- NetworX Configuration Analyst will need to identify, manage and document the status of open issues
Interpret provider contracts and configure NetworX or Pricer (creating new agreement templates and defaults if needed or updating existing) for the following types of agreements: Professional, Ancillary, ASC, SNF, Hospital, etc.
- Ensure contract templates can be administered across operations (pricing config, claims, etc.)
- Communicate identified discrepancies to Network Management, Contracting and Pricing Requirement teams
- Reviews company specific, CMS specific, State specific and competitor specific medical policies and reimbursement policies
- Review pricing configuration structure and provider billing set-up to ensure contract loading accuracy
Identify multiple potential solutions to resolve claims issues
- Conduct testing of proposed solutions and/or changes made to determine their effectiveness and make necessary modifications
- Review recommended or requested solutions and provide appropriate approvals needed to implement corrective solutions
- Conduct and/or participate in regular meetings with internal and/or external business partners to share relevant information and discuss pricing requirements
- Create and/or provide loading documentation to instruct internal business partners on contract/non par loading procedures
- Leads projects related to provider reimbursement initiatives
- Works with provider contracting staff when new/modified reimbursement contracts are needed
- Performs pre-adjudication claims reviews to ensure proper coding was used
- Communicate and/or collaborate with internal business partners to identify process improvement opportunities
- Perform SQL queries to pull reports when necessary
- Assist with audits and other quality controls to proactively identify issues
- Perform audits of new and/or existing provider contracts to ensure accuracy of set up accurately into appropriate systems (e.g., NetworX)
- Prioritize workloads
This high-impact position is challenging. You will be working with configuration analysis to ensure loads into our system are accurate based on our contracts, so the ability to use data and facts to identify and solve a range of problems is critical to your success.
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.
- Subject Matter Expert (SME) in Facility/Ancillary and Professional Provider Configuration Reimbursement as no training is offered
- 4+ years of experience with Facility/Ancillary and Professional Provider reimbursement methodologies without loading guidelines into various platforms
- 3+ years of experience with claims processing systems using NetworX (familiar with CPT, HCPCS, DRG, Revenue, ICD-10, etc.)
- Demonstrated NetworX experience doing Pricing Configuration
- Optum Rate Manager experience with Medicare, State, and custom records
- Experience with CMS Guidelines and State Specific Pricing
- MS Office: Excel, Word, and some MS Access
- Proven ability to work multiple projects simultaneously
- Proven ability to manage multiple projects concurrently while maintaining a high level of quality and commitment to project timeframes
- Proven ability to communicate and collaborate with internal customers
- Proven self-directed and experience multi-tasking effectively between two or more activities or sources of information
- Proven critical thinking skills
*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 California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Rhode Island, or Washington residents is $70,200 to $137,800 annually. Pay is based on several factors including but not limited to education, work experience, certifications, etc. 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: 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.