Provider Installation Administrator - Phoenix, AZ

Company:	UnitedHealth Group Company Profile \| Current Opportunities (64)
Job Location(s):	Phoenix
Employment Term:	Regular
Employment Type	Full Time
Start Date:	As soon as possible
Starting Salary Range:	Not Provided
Required Experience:	Open
Related Categories:	Miscellaneous

Position Description

Provider Installation Administrator - Phoenix, AZ-329552

Description

Position Description:

What makes your career greater with UnitedHealth Group? Growth opportunities among the variety of product lines and making an impact on the healthcare system ensures it will always be challenging and interesting. The Provider Installation Administrator is responsible for the installation and administration of assigned contracts, including, but not limited to: structure and billing set up, eligibility collection, database loading, and preparation of plan materials such as administrative documents and provider education materials. Provider Installation Administrators are also responsible for overall provider contract and amendment loading and processing using various databases. Responsibilities may also include auditing contract loads for adherence to quality measurers and reporting standards. Positions in this function are responsible for reviewing contract terms and payment methodologies on provider contracts to load contract terms and pricing into the Diamond platform for Americhoice business. This position includes reviewing and resolving provider pended claims and appeals as they relate to pricing or provider contract, analyzing contract terms to assess the best method for configuring the contract terms into Diamond.

Primary Responsibilities:

Main accountability to lead and coordinate PCM team activities and tasks as related to configuration options and/or business processes and projects
Reads, interprets and perform configuration duties into Diamond
Provides high level technical advice and solutions for configuration into Diamond and report generation and analysis
Interacts with key business partners, including, but not limited to: Claims Operations, IT, Project Management, Health Plan Operations, Network Management
Reviews, interprets, and loads provider contracts into the Diamond claims payment platform to support AmeriChoice business
Provides high level configuration analysis and approach to ensure contract load into Diamond per contract pricing language
Develop, analyze, and monitor new, routine, and ad hoc reports using standard database tools
Evaluate, interpret and analyze data, configuration options, and/or business processes
Collect, analyze and document business requirements for cross functional projects
Lead and coordinate configuration teams in cross functional project and achieve timely and accurate deliveries
Works with team members to provide configuration guidance, training and technical direction
Works with other departments to clarify project/contract intent and payment methodologies
Participates in work groups to provide reporting and analysis support, as needed
Applies working knowledge in medical/claim coding to ensure system configuration adheres to Medicare, Medicaid, and other federal/state regulations
Able to comprehend and apply industry payment methodologies to configuration and claims research
Perform other duties as assigned by department management

AmeriChoice is part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system.

If you're ready to help make health care work better for more people, you can make a historic impact on the future of health care at AmeriChoice.

We contract with states and other government agencies to provide care for over two million individuals. Working with physicians and other care providers, we ensure that our members obtain the care they need with a coordinated approach.

This enables us to break down barriers, which makes health care easier for our customers to manage. That takes a lot of time. It takes a lot of good ideas. Most of all - it takes an entire team of talent. Individuals with the tenacity and the dedication to make things work better for millions of people all over our country.

You can be a part of this team. You can put your skills and talents to work in an effort that is seriously shaping the way health care services are delivered.

Qualifications

Qualifications:

Demonstrated experience interpreting institutional, ancillary, and professional contracts and fee schedules is required
3 years experience working with provider contract configuration in a major claims processing system is required
3 years experience working with provider contract configuration in a major claims processing system is required
Demonstrated knowledge of claims coding and payment principles and contract configuration is required
Experience participating in medium to large projects and/or leading small projects is required
Experience in work flow process improvement projects is required
Medicaid and/or Medicare experience is preferred
Experience with Microsoft Access and SQL a plus
Six Sigma experience is a plus
Experience working with Facets and/or Diamond is highly preferred

Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.

Job Provider Contract Installation

Primary LocationUS-AZ-Phoenix

Organization AMC Network Planning & Dvlpmnt

Schedule Full-time

Number of Openings 1