Provider Reimbursement Specialist

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. Optum has an immediate opening for a Provider Reimbursement Specialist Schedule: Mon - Fri, 8:00AM - 5:00PM any time zone that you reside within You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Research and develop applicable business rules that support product reimbursement methodologies and policies for existing and new business opportunities. Develop and submit fee schedules and/or provider rates to claim pricing platforms. Perform post-load quality analysis review on relevant claim platform submissions and provide correction instructions if necessary Write technical specifications or business requirements that support the development of business applications or existing system enhancements Perform and/or review user acceptance testing of relevant applications (e.g., support fee schedule; rate submissions; fee builder tool; claim editing system; claim pricing system) Write internal operational and/or reimbursement policies that support global functions. Work with business partners to develop and/or create provider agreements and payment appendices to reflect terms of the provider's reimbursement strategies Research new opportunities to improve operating efficiencies, implement medical cost savings and/or reduce administrative expenses, and provide appropriate recommendations to applicable audiences. Review State websites for the markets assigned on a weekly basis to research any Fee Schedule changes and submit to PCRL to ensure most appropriate pricing is documented and loaded in our systems. Performs other duties as assigned What are the reasons to consider working for UnitedHealth Group? Put it all together - competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include: Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays Medical Plan options along with participation in a Health Spending Account or a Health Saving account Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage 401(k) Savings Plan, Employee Stock Purchase Plan Education Reimbursement Employee Discounts Employee Assistance Program Employee Referral Bonus Program Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.) 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.

High School Diploma/GED 2+ years of experience working on CSP FACETs 1+ years of experience supporting professional reimbursement 1+ years of experience with provider contracts and/or interpretation of the State requirements but not limited to RFPs and contracts Intermediate to Advanced level of proficiency in Microsoft programs including Excel and Word Access to a designated quiet workspace in your home (separated from non-workspace areas) with the ability to secure Protected Health Information (PHI) Live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service Preferred Qualifications: Experience in