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Provider Reimbursement Representative - Ontario, CA

UnitedHealth Group

Ontario, CA
Job Code:
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Job Details

Provider Reimbursement Representative - Ontario, CA(Job Number:719845)

Position Description:
Energize your career with one of Healthcare’s fastest growing companies.  
You dream of a great career with a great company - where you can make an impact and help people. We dream of giving you the opportunity to do just this. And with the incredible growth of our business, it’s a dream that definitely can come true. Already one of the world’s leading Healthcare companies, UnitedHealth Group is restlessly pursuing new ways to operate our service centers, improve our service levels and help people lead healthier lives. We live for the opportunity to make a difference and right now, we are living it up.
This opportunity is with one of our most exciting business areas: Optum - a growing part of our family of companies that make UnitedHealth Group a Fortune 17 leader.
Optum helps nearly 60 million Americans live their lives to the fullest by educating them about their symptoms, conditions and treatments; helping them to navigate the system, finance their healthcare needs and stay on track with their health goals. No other business touches so many lives in such a positive way. And we do it all with every action focused on our shared values of Integrity, Compassion, Relationships, Innovation & Performance.
As a Provider Reimbursement Representative, you will conduct ongoing evaluation, analysis, and organization of all cap related procedures to accurately calculate monthly PCP and specialty provider capitation payments according to contractual terms.
Primary Responsibilities: 
  • Comprehends Provider contracts, is able to determine capitation terms and effectively incorporate changes and / or updates for configuration. Appropriately tests all changes for accuracy and implements into the cap process
  • Identify and configure necessary additions, changes and deletions to new and existing configuration design as it relates to capitation
  • Originates scheduling of pre-cap/ post-cap calculations and capitation reports. Coordinates report extractions with Business Analyst and team members. Identifies variances and issues, analyzes and implements data for review, communicates issues and receives approvals from Executive Directors
  • Ensures accuracy of data on Excel spreadsheets by verifying proper linking. Audits raw data, compares with worksheets to verify proper PCP / Specialty cap calculations. Generates and submits PCP / Specialty cap payment upload requests to Accounts Payable for processing
  • Works with Lead, Business Analysts and Manager, in troubleshooting system and reporting or process issues. Must be able to effectively analyze issues and communicate problem-solving ideas
  • Reconciles PCP / Specialty cap expense to general ledger. Generates cap related reports to perform PCP / Specialty audits, adjustments, check requests, analyses, research and special projects, as required
  • Collaborates with the IS staff in developing and testing of system upgrades
  • Utilizes various computer programs to research provider, member and eligibility information. (Claims System / Claims System test, Crystal, Excel, Word, Access, Great Plains)

Job Provider Reimbursement
Primary Location US-CA-Ontario
Other Location 
Organization NAMM California
Schedule Full-time
Number of Openings 1
Apply on the Company Site

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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