UHG

About UHG

Careers at UnitedHealth Group

 

We have modest goals: Improve the lives of others. Change the landscape of health care forever. Leave the world a better place than we found it. Such aspirations tend to attract a certain type of person. Crazy talented. Compassionate. Driven. To these individuals, we offer the global reach, resources and can-do culture of a Fortune 5 company. We provide an environment where you’re empowered to be your best. We encourage you to take risks and in return, offer a world of rewards and benefits for performance. Exceeding your limits is an exceptional start to your life's best work.SM

 

Just like you, we are driven by a set of fundamental principles that are guiding our way forward. Our values of integrity, compassion, relationships, innovation, and performance serve as a foundation to transform health care. Are you in? Learn more about your future at UnitedHealth Group at careers.unitedhealthgroup.com

 

Job Category:

Business Operations

Country:

United States

Postal Code:

55343

Approximate Salary:

Not Specified

Position Type:

Full Time

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Associate Business Process Analyst - Cypress CA or Eden Prairie MN

UHG - Eden Prairie, Minnesota

Posted: 09/13/2018

This role operates as a team lead or subject matter expert on the Data Validation and Provider Outreach team. The role oversees individuals, and performs responsibilities, involved in managing PHI, data preparation, provider outreach and QA functions in support of company programs including Hospital Data Capture (HDC), Medicaid program, Physician Query (PQ), MA RADV and ACA RADV (Medicare Advantage and Affordable Care Act).  This team interfaces with provider offices, hospitals and other facilities to gain additional information needed under various CMS mandates. 

 

Primary Responsibilities:

  • Acts as team lead and / or subject matter expert for program and processes

  • Responsible for addressing questions regarding process for new and existing programs

  • Serves as training partner for newer staff and contractors

  • Oversee work production and performance of assigned team of contractors

  • Works with senior management by providing suggestions for improvement regarding processes, workflow tools, and reporting

  • Track common colleague questions / issues and provide feedback for senior management on how to mitigate these questions / issues

  • Act as a secondary level of contact for escalated issues relating to the provider

  • Assist Manager with various tasks

  • Program Expertise

    • Develop knowledge and expertise in each program type including regulatory / compliance guidelines, program specific workflow tools and processing requirements and rules

    • Prioritize workload and work multiple program types in a given week. (Provider Query, Hospital Data Capture, Medicaid Chart Review)

    • Develop and maintain effective relationships with providers to ensure strong program participation and quick response times

  • Data Analysis

    • Review and manage performance metrics of designated team members and contractors.

    • Work between several data platforms simultaneously to create packages to send to provider offices

    • QA all content prior to sending requests

    • Identify and escalate records that do not meet content standards

    • Submit final packages through required data control/and release protocols

    • Actively participate in providing feedback for future iterations of technology platform like RUBY

    • Utilizes applicable programs and applications to analyze data sets; Identifies file differentiation and scrubs for selected data

  • Development and Implementation of Communication Strategies

    • Outline appropriate communication strategy using knowledge of provider, programs, and contract approaches to drive highest level of participation

    • Prioritize contact strategy based on different factors including aging, provider contact history / responsiveness, request value or other factors as influenced by the specific program

    • Research and locate providers - finding those who have moved to new employer, closed a clinic or practice, or moved -  and contact provider facilities to confirm contact and provider information

    • Apply appropriate communication strategies based on status of each contact and information requested (initial, reminder, past due, resend, PNP)

    • Contact providers to explain program and request, set commitments for information return and explain options for completing and transmitting information

    • Influence response of provider while ensuring legal, ethical, and regulatory guidelines are met related to advisement and influence of coding decisions made by providers

  • Provider Relations

    • Manage assigned provider relationships across multiple programs

    • Develop and manage on-going relationships with designated providers and facilities to reduce provider abrasion, drive program participation and enhance productivity and efficiency

    • Evaluate current methods of outreach and create improvements that can be implemented to positively impact provider participation

  • Program Participation

    • Conduct QA on returned provider request when needed, and be able to differentiate between errors and acceptable returns

    • Review escalations and determine appropriate course of action

    • Anticipate and troubleshoot provider non-participation and create persuasive support for quick resolution of resistance

    • Meet daily and weekly production standards

    • Apply appropriate advisement and influence to drive program success

  • Legal and Plan Compliance

    • Ensure provider communication meets legal and regulatory guideline regarding coding advisement and release of PHI

    • Responsible for designated team meeting all standards for Quality

    • Understand and apply rules for medical information handling across multiple programs and situations


Required Qualifications:

  • Bachelor's Degree OR High School Diploma / GED
  • 5+ years of Customer Service experience with preference in Hospital services or Provider services
  • 2+ years of previous experience in Hospital Billing, Coding or Claims processing
  • 4+ year experience utilizing MS Office applications and other data table management tools
  • Excellent communication skills such as written / verbal / telephonic phone skills, including ability to adapt style based on situation
  • Ability to work independently and prioritize workload to meet productivity goals
  • Ability to use good judgment when evaluating request content and relevant information
  • Understanding of and ability to apply compliance standards across multiple program types and situations
  • Adaptable - able to move across different work and program types in short time periods
  • Ability to articulate experience with workflow tools to support future modifications
  • Excellent attention to detail - able to perform QA functions

 

Preferred Qualifications

  • 2+ of experience as team leader or SME
  • 1+ year experience working with Provider Query, HDC, Medicaid Chart Review

 

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)

 


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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