Job Abstract

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 startCaring. Connecting. Growing together.

Under limited supervision by the Manager, Revenue Integrity, this position is responsible for compliant Charge Description Master (CDM) functions including, but not limited to, reimbursement analysis with monitoring of Revenue compliance across multi-disciplinary teams to evaluate charge capture process. Responsible for the implementation of negotiated payer rates within the Hospital Billing software.

Youll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Operational/Procedural Responsibilities
  • Serves as an internal resource to clinical departments around charge capture and charge master updates
  • Works with the revenue producing departments to ensure the ongoing coordinated consistency of the Chargemaster, including accurate descriptions, coding, additions, deletions, pricing and any other changes
  • Monitors revenue compliance with clinical departments, evaluating charge capture processes for new and existing services, implementing best practices
  • Participates in ongoing coordination and resolution of revenue issues as they arise ensuring the overall integrity of the charge capture process
  • Maintains corporate charge master to support Affiliates in the Bassett Healthcare Network by providing education and planning activities to ensure consistency and standardization of the charge masters
  • Monitors facility charging mechanisms and systems with in-depth knowledge of how orders and charges are entered and of the various system workflows to insure proper generation of charges for billing
  • Analyzes reports to determine areas of improvement and determine appropriate plan of action by reviewing data and systems to target areas of improvement
  • Maintain timely turnaround of all Chargemaster requests.(New codes, price changes, etc.)
  • Maintain high productivity and quality with minimal supervision
  • Yearly continuing education is required
  • Ability to multi-task and work under aggressive deadlines
  • Possess effective time management skills to permit handling of a large workload
• Financial Responsibilities
  • Supervision and coordination of Chargemaster management functions in researching coding and billing guidelines, researching third party contract negotiated rates, and updating the system Charge masters
  • Performs analyses to understand net revenue effect of proposed Chargemaster changes in conjunction with finance and clinical operations
  • Coordinates, implements and manages charge capture initiatives and the process to protect and improve revenue capture including oversight of the CDM functions and reimbursement analyses specific to applicable clinical systems and Affiliates
  • Ability to understand and analyze payer regulations and impact to the Chargemaster on reimbursement and coding guidelines
  • Disseminates CMS updates to health care providers and clinical departments as they relate to billing for drugs, implantable and/or other pass-through eligible items, ensuring the necessary changes are made to the entity specific Chargemaster files within appropriate timeframes for accurate and compliant billing
  • Conducts internal reviews to improve revenue cycle, claims production and coding integrity
  • Monitors compliance with corporate, federal, and state guidelines bringing forward changes, as applicable, while focusing on accuracy and revenue cycle integrity
  • Maintains a solid working knowledge of the revenue cycle process to aid in the implementation of regulatory standards assuring appropriate and timely cash collection
  • Troubleshoots and resolves issues related to the revenue cycle by developing, presenting and implementing recommendations
• Responsibilities for Relationships
  • Develop and maintain solid working relationships with internal and external customers
  • Collaborate with managerial and supervisory staff to ensure compliant regulatory billing with correct coding on accounts
• Maintaining Negotiated Payer rates and grouper modules
  • Work with Manager, Revenue Cycle & Contracting to obtain current negotiated rate changes from participating carriers, updating billing software with applicable changes
  • Remains current with updated coding and billing regulations.Monitoring all negotiated payer rate changes, including government groupers APC, APG, APDRG, APRDRG, and MSDRG
  • Monitors and audits these changes to ensure proper reimbursement is received from these payers
  • Updates the quarterly government grouper changes APC, and APG to insure they are working correctly
  • Works with Reimbursement Manager on DRG changes for each payer
• Performs similar or related duties as requested or directed
  • Performs other duties as requested and observed by supervisor or manager

Youll 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.

Required Qualifications:

• 10+ years relevant experience e.g. patient billing and revenue cycle experience, experience in finance within a healthcare organization
• Proven extensive knowledge of CPT/HCPCS, UB-04 Revenue Coding, modifiers, billing regulations APCs, APGs and DRGs
• Proven understanding of the CDM and its relationship to related areas such as the General Ledger, cost Accounting, Productivity, Cost Reporting and Budget
• Proficient in the use of Microsoft Office Programs, including but not limited to Excel, Word, and Access
• Proven solid analytical skills
• Proven solid oral and written communication skills; analytical and computer skills

Preferred Qualifications:

• Financial related work experience
• Knowledge of revenue cycle processes within a healthcare organization
• Knowledge of CMS coding and compliance rules
• Knowledge of Epic
• Knowledge of clinical settings such as Laboratory, Radiology, Physical or Occupational Therapy, Respiratory Therapy, Cardiology, or Oncology
• Proven ability to research complex coding and regulatory requirements
• Proven ability to organize and assess various statistical and financial data and put forth conclusions based on data collected
• Proven ability to multi-task, managing interruptions in daily routine; ability to resume detailed work with limited time for re-orientation
• Proven ability to accomplish a defined scope of job performance through independent investigation, self-motivation, analytical and problem- solving techniques
• Proven ability to read and compose business correspondence and communicate effectively with all levels of the organization and external parties

*All employees working remotely will be required to adhere to UnitedHealth Groups Telecommuter Policy

California, Colorado, Connecticut, Hawaii, Nevada, New York, New Jersey, Rhode Island, or Washington Residents Only: Thesalary range for this role is $70,200 to $137,800 annually. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, youll find a far-reaching choice of benefits and incentives.

Application Deadline:This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyoneof every race, gender, sexuality, age, location and incomedeserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

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.