UnitedHealth Group
Senior Business Analyst Revenue Integrity - Remote
UnitedHealth Group, St Louis, Missouri, United States,
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 start Caring. 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.
You’ll 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
You’ll 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:
High School diploma
10+ years relevant experience e.g. patient billing and revenue cycle experience, experience in finance within a healthcare organization
5+ years of experience CPT/HCPCS, UB-04 Revenue Coding, modifiers, billing regulations APC’s, APG’s and DRG’s
5+ years of experience with the CDM and its relationship to related areas such as the General Ledger, cost Accounting, Productivity, Cost Reporting and Budget
3+ years of knowledge with Epic
Proficient in the use of Microsoft Office Programs, including but not limited to Excel, Word, and Access
Preferred Qualifications:
10+ years of revenue cycle processes within a healthcare organization
5+ years of experience with Financial related work experience
5+ years of CMS coding and compliance rules
5+ clinical settings such as Laboratory, Radiology, Physical or Occupational Therapy, Respiratory Therapy, Cardiology, or Oncology
Familiarity with Epic - Resolute and clinical apps
*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy
California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Rhode Island, Washington, Washington, D.C. Residents Only: The salary 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, you’ll 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 everyone–of every race, gender, sexuality, age, location and income–deserves 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.
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.
You’ll 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
You’ll 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:
High School diploma
10+ years relevant experience e.g. patient billing and revenue cycle experience, experience in finance within a healthcare organization
5+ years of experience CPT/HCPCS, UB-04 Revenue Coding, modifiers, billing regulations APC’s, APG’s and DRG’s
5+ years of experience with the CDM and its relationship to related areas such as the General Ledger, cost Accounting, Productivity, Cost Reporting and Budget
3+ years of knowledge with Epic
Proficient in the use of Microsoft Office Programs, including but not limited to Excel, Word, and Access
Preferred Qualifications:
10+ years of revenue cycle processes within a healthcare organization
5+ years of experience with Financial related work experience
5+ years of CMS coding and compliance rules
5+ clinical settings such as Laboratory, Radiology, Physical or Occupational Therapy, Respiratory Therapy, Cardiology, or Oncology
Familiarity with Epic - Resolute and clinical apps
*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy
California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Rhode Island, Washington, Washington, D.C. Residents Only: The salary 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, you’ll 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 everyone–of every race, gender, sexuality, age, location and income–deserves 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.