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Provider Reimbursement Representative - San Antonio, TX

UnitedHealth Group

San Antonio, TX
Job Code:
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Job Details

762560 Provider Reimbursement Representative San Antonio TX

Provider Reimbursement Representative - San Antonio, TX (762560)

Position Description

Welcome to one of the toughest and most fulfilling ways to help people, including yourself. We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement. Join us and start doing your life's best work.

It's that time, isn't it? You're ready for the next step forward and an opportunity to build on your skills. And it just so happens that there's never been a better time to become a part of the team at UnitedHealth Group. We're driving ever higher levels of sophistication in how provider networks are composed and compensated. You can help drive positive change in this role. You'll be part of a team that's out to assist company affiliates with initial deployment and ongoing support of systems and processes that leverage contracted national network rates and policies. Join us and you'll discover the resources, backing and opportunities that you'd expect from a Fortune 6 leader.

In this role, you'll need to be able to work quickly and accurately, in order to effectively develop and manage provider networks. You'll need to learn and adapt to a variety of platforms while working to meet aggressive performance objectives.

Primary Responsibilities:
  • Coordinate development between customer, network and United Medical Resources (UMR) internal departments
  • Onboarding, maintenance and administration of networks
  • Contract Automation
  • Assist with programs designed to ensure proper application of contracted rates and reimbursement policies for company affiliates
  • Analyze claims, pre and post payment, to ensure proper pricing of contracts, reimbursement policies and procedures
  • Review claim disputes to verify correct pricing and analyze claim inquiry data to determine root cause of errors
  • Recommend system changes, training and process improvements to prevent future errors
  • Act as a technical resource to others and proactively identify solutions to non-standard requests
Required Qualifications:
  • High School Diploma / GED (or higher) or equivalent work experience
  • 1+ years of experience in a position related to managing hospital, physician, dental, and / or pharmaceutical networks that support a client base
  • 1+ years of experience in claims research, analysis and reporting
  • Ability to create, edit and save documents in Microsoft Excel, Microsoft Word, and Microsoft PowerPoint
Preferred Qualifications:
  • 1+ years of experience utilizing the CPS claims platform within UMR
Soft Skills:
  • Ability to communicate at both an individual and team level
Careers at UnitedHealthcare Employer & Individual. We all want to make a difference with the work we do. Sometimes we're presented with an opportunity to make a difference on a scale we couldn't imagine. Here, you get that opportunity every day. As a member of one of our elite teams, you'll provide the ideas and solutions that help nearly 25 million customers live healthier lives. You'll help write the next chapter in the history of health care. And you'll find a wealth of open doors and career paths that will take you as far as you want to go. Go further. This is your life's best work.

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.

Keywords: UHG, OptumRx, UMR, CPS, reimbursement, provider networks, San Antonio, TX, claims review, claims research

Job Details

  • Contest Number762560
  • Job TitleProvider Reimbursement Representative - San Antonio, TX
  • Job FamilyNetwork Management
  • Business SegmentEmployer and Individual

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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