Great sales are the result of strong purpose, conviction and pride - pride in your ability and your product. UnitedHealth Group offers a portfolio of products that are greatly improving the life of others. Bring along your passion and do your life's best work.(sm)
Our Product Development and Management groups are vital to our success and are leaders in driving the future growth of UnitedHealth Group. Success in these careers relies on many factors - your ability to deal with ambiguity, your ability to adapt and embrace change, and a long - term commitment to making health care better for everyone. This position is responsible for researching, defining and implementing the requirements for Medicaid Claims as defined by state policy. This position will work closely with the application teams in ensuring that requirements are correctly defined and administered.
You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
- Accurately interpreting national reimbursement policies and coding guidelines for utilization in Optum coding products
- Ability to research source information from CMS and state Medicaid sources
- Develop documentation to identify sources of edits
- Develop and maintain Medicaid specific edits
- Working closely with application development to ensure proper claims processing
- Reviewing, researching and responding to client issues and / or concerns
- Anticipates customer needs and proactively develops solutions to meet them
- Audit existing rules as well as maintaining ongoing testing for new development
- Identifies solutions to non - standard requests and problems
- Solves moderately complex problems and / or conducts moderately complex analyses
- Works with minimal guidance; seeks guidance on only the most complex tasks
- Translates concepts into practice
- Provides explanations and information to others on difficult issues
- Coaches, provides feedback, and guides others
- Acts as a resource for others with less experience
- Assesses and interprets customer needs and requirements
- Bachelor’s degree or equivalent work experience
- 3+ years of experience with Medicaid local and national coverage determination policies
- Experience creating professional documentation such as writing business requirements, proposal, clinical requirements, etc.
- Strong technical writing skills
- 3+ years basic experience with MS Word, Excel, Outlook
- Excellent written and verbal communication skills
- Demonstrated ability to manage and prioritize deliverables
- Proven organizational skills with ability to be flexible and work with ambiguity
- Auditing / testing experience
- Experience with clinical requirements for claims processing applications
- Coding Certification (examples: CPC, CCS, RHIT, RHIA, etc.)
- An extensive background in medical claims processing, appeals resolution, facility / provider coding experience or reimbursement policy
- Experience presenting to senior level management
Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care 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)
*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.
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: Medicaid, CPC, CCS, RHIT, RHIA, Coding, Telecommute, Telecommuter, Telecommuting, Remote, Work from home