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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:

Information Technology

Country:

United States

Postal Code:

78201

Approximate Salary:

Not Specified

Position Type:

Full Time

Manager of Submissions - WellMed - San Antonio, TX

UHG - San Antonio, Texas

Posted: 09/2/2018

The Manager of Submissions, Risk Adjustment, supervises, directs, plans, and organizes the processes that drive the collection, submission, deletion and reporting of data required by the Centers for Medicare and Medicaid Services (CMS). This position consults on the development, specification and integration of WellMed’s Risk Adjustment Submissions and Reconciliation systems and will analyze business needs, document requirements, translate needs into functional and / or technical specifications, write and execute test cases and plans, and oversee testing processes. This position will oversee day-to-day operations of WellMed’s Risk Adjustment Submissions and Reconciliation processes.

 

Primary Responsibilities:

  • Develops policies and procedures for system, application and related operational processes in order to ensure optimization and compliance with established standards and regulations internally at WellMed and externally with CMS or other regulating body

  • Provides short range trouble shooting for day-to-day issues and ongoing maintenance with Risk Adjustment Submissions and Reconciliation applications and reporting.  Makes recommendations as needed to ensure reliability of the systems and finds innovative solutions if problems should occur

  • Ensures that the risk adjustment diagnostic submissions to CMS and/or health plans or their intermediary occur timely and accurately; this includes additions and deletions where appropriate

  • Provides claims/encounter data reconciliation between CMS and/or health plans or intermediary with business claims and coding detail to ensure accurate risk adjustment payments on behalf of provider groups

  • Defines project scope and objectives based on business needs combined with a thorough understanding of enterprise business systems and industry requirements

  • Performs a major role in the development and implementation of major systems. This role may interface with multiple business units such as accounting/finance, claims, operations, physician clinics, customer service, executive management, and sales and marketing

  • Serves as an expert resource regarding the alignment of enterprise system strategies with the business goals and strategic drivers

  • Applies knowledge of managed care operating environment and underlying systems data to all major production systems used for delivery of services to internal and external clients

  • Develops and maintains strong relationships with both internal/externals customers at the senior management and executive level in order to influence project teams and gain consensus on the selection of the most viable solutions. The position acts as a key team member to both IT and the business

  • Uses strong critical thinking skills along with managed care, or physician office business knowledge to have insight and understanding of business concepts, tools and processes that are needed for making sound decisions in the contact of the company’s business

  • Tracks progress and notifies management of issues that require escalation, and assumes responsibility for resolving or coordinating the resolution of system and process issues

  • Develops and maintains project plans, and manages specific tasks to ensure project success

  • Collaborates on and oversees various projects as assigned that are cross-functional in nature

  • Perform all supervisory duties as needed to support a team of five or more members

  • Performs all other related duties as assigned

 


Required Qualifications:

  • Bachelor’s degree in Finance, Business, Computer Science, Information Systems or related technical field (4+ years of comparable work experience beyond the required years of experience may be substituted in lieu of a bachelor’s degree)

  • 5+ years of experience in developing requirements and performing system analysis

  • 1+ year’s supervisory experience

  • 3+ years of experience leading technical projects or teams

  • Experience with various system development lifecycles such as waterfall, and Agile methods

  • Ability to communicate ideas and problem solutions

  • Ability to effectively work with both internal and external clients

  • Working knowledge of Medicare Risk Adjustment and/or Medical Claims processing

Preferred Qualifications:

  • Advanced degree in a related discipline

  • 2+ years of experience in Health Care

  • 3+ year’s supervisory experience

  • 5+ years of experience in one or more of the following areas: systems design, database programming experience, HL7 integration, X12 integration, EDI, practice management system implementation and support, EMR system implementation and support, Claim adjudication system implementation and support, Care Management system implementation and support

Physical & Mental Requirements:

  • Ability to lift up to 25 pounds

  • Ability to push or pull heavy objects

  • Ability to sit for extended periods of time

  • Ability to stand for extended periods of time

  • Ability to use fine motor skills to operate office equipment and/or machinery

  • Ability to properly drive and operate a company vehicle

  • Ability to receive and comprehend instructions verbally and/or in writing

  • Ability to use logical reasoning for simple and complex problem solving

Careers with WellMed. Our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors. We're impacting 240,000+ lives, primarily Medicare eligible seniors in Texas and Florida, through primary and multi-specialty clinics, and contracted medical management services. We've joined Optum, part of the UnitedHealth Group family of companies, and our mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness. Our providers and staff are selected for their dedication and focus on preventative, proactive care. For you, that means one incredible team 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.

 

 

Job Keywords: Manager of Submissions, WellMed, San Antonio, TX, Texas

 

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