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The Community & State Encounter Program Management team has oversight of complete, timely and accurate encounter (claim) submissions to state customers. This includes working with health plans and states on process improvements, implementing new requirements and analyzing current production results. A Medicaid Encounter Senior Claims Business Process Consultant is a Subject Matter Expert (SME) for one or more states, responsible for establishing a thorough understanding of state encounter requirements and meeting or exceeding those encounter requirements and internal goals by correcting encounters with issues in order to get them accepted by our state customers.
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. If you are located in the MST / CST area, you will have the flexibility to telecommute* as you take on some tough challenges. Training will be conducted virtually from your home.
Gathering, reading and understanding state requirement documentation, then translating into business requirements documents
Correcting encounter failures and identifying root causes and remediating the issues demonstrating deeper understanding of upstream and downstream impacts and the bigger picture. Participating in the solution process and monitoring on-going encounters to ensure complete resolution.
Gathering and utilizing status against goal metrics (includes contractual requirement measurements, financial completeness reports and financial completeness plans) to identify new issues, prioritizing work, and communicating to leader; communicating program activities and health to health plan leadership, typically more end to end rather than on specific topics only
Developing collaborative relationships with internal partners impacting encounters, including health plans.
Performing interaction with state partners in order to research issues
Hosting or participating in regular meetings with health plans; includes providing clear examples of issue analysis to share with health plans, other functional teams and states to get assistance on resolution, knowing what data is relevant for the audience
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 (or higher)
4+ years of work experience in the healthcare industry analyzing data or any experience with claims with SQL knowledge
Intermediate or higher level of proficiency with Microsoft Word (ability to create, copy, edit, send and save documents) and Microsoft Excel (creating pivot tables, formulas and functions, V-lookups, manipulate large data sets)
Must live in a location that can receive a UnitedHealth Group approved high - speed internet connection or leverage an existing high - speed internet service
If you need to enter a work site for any reason, you will be required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or similar UnitedHealth Group-approved symptom screener. When in a UnitedHealth Group building, employees are required to wear a mask in common areas. In addition, employees must comply with any state and local masking orders
Bachelor's degree (or higher)
Experience with Medicaid Encounters, Medicaid Claims or other related functions, such as Provider Data or Enrollment
Experience working with PL/SQL within an Oracle Data base
Experience working in a matrix-style organization
Ability to problem solve and research conflicting and / or inaccurate data
Ability to communicate analysis, including trends and opportunities, to partners and customers in writing and verbally
Ability to work on multiple priorities
UnitedHealth Group is an essential business. The health and safety of our team members is our highest priority, so we are taking a science driven approach to slowly welcome and transition some of our workforce back to the office with many safety protocols in place. We continue to monitor and assess before we confirm the return of each wave, paying specific attention to geography-specific trends. At this time, 90% of our non - clinical workforce transitioned to a work at home (remote) status. We have taken steps to ensure the safety of our 325,000 team members and their families, providing them with resources and support as they continue to serve the members, patients and customers who depend on us. You can learn more about all we are doing to fight COVID-19 and support impacted communities at: https://www.unitedhealthgroup.com/newsroom/addressing-covid.html
Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 10 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near - obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, Military families and Veterans wherever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can do your life's best work.SM
Colorado Residents Only: The salary range for Colorado residents is $64,800 to $116,000. Pay is based on several factors including but not limited to education, work experience, certifications, etc. As of the date of this posting, In addition to your salary, UHG offers the following benefits for this position, subject to applicable eligibility requirements: Health, dental, and vision plans; wellness program; flexible spending accounts; paid parking or public transportation costs; 401(k) retirement plan; employee stock purchase plan; life insurance, short-term disability insurance, and long-term disability insurance; business travel accident insurance; Employee Assistance Program; PTO; and employee-paid critical illness and accident insurance.
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.
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