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Contract Configuration Specialist - (Healthcare Claims) San Antonio, TX

UnitedHealth Group

San Antonio, TX
Job Code:
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Job Details

734040 Contract Configuration Specialist San Antonio TX

Contract Configuration Specialist - (Healthcare Claims) San Antonio, TX (734040)

Position Description

The Contract Configuration Specialist supports network contracting teams and claims team through properly configuring contracts based on CMS / contract methodologies for accurate claims payment.
Primary Responsibilities:
  • Manages and configures contract reimbursement methodologies within specified timeframes into claims payment system
  • Tests and audits claims payment accuracy against contract information loaded into claims payment system
  • Partners with other departments to ensure appropriate data is collected and maintained
  • Interprets and configures contract terms and claims coding in a risk based environment
  • Understands health insurance benefit administration in a risk based environment
  • Utilizes data in the development and implementation of managed care strategies
  • Acts as a resource to other internal departments on contract issues
  • Expected to meet or exceed departmental timeframes and quality metrics on a consistent basis
  • Takes ownership of the work process, seeks ways to improve job and process efficiency and makes appropriate suggestions and solutions to management
  • Performs all other related duties as assigned
Required Qualifications:
  • High school diploma or GED equivalent
  • 5 or more years of health care claims processing experience
  • Medical terminology, 10 key and computer literacy
  • Proficient with Medicare processing guidelines, RBRVS, facility and ambulatory payment methodologies
  • Exceptional ability to organize, prioritize and communicate effectively
  • 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 90,000+ 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 Details

  • Contest Number734040
  • Job TitleContract Configuration Specialist - (Healthcare Claims) San Antonio, TX
  • Job FamilyClaims
  • Business SegmentOptumCare

Job Location Information

  • San Antonio, TX
    United States
    North America

Additional Job Detail Information

  • Employee StatusRegular
  • ScheduleFull-time
  • Job LevelIndividual Contributor
  • ShiftDay Job
  • TravelNo
  • Telecommuter PositionNo
  • Overtime StatusNon-exempt

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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