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Reimbursement Analyst, Contract Modeler - Rancho Cordova, CA

UnitedHealth Group

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Reimbursement Analyst, Contract Modeler - Rancho Cordova, CA(Job Number:722945)

Here, your performance, your ideas, your unique analysis will combine with a rich assortment of contributors to understand and shape the health care system. At UnitedHealth Group, you'll work with a team that has the creativity and passion to help build new health care solutions that meet emerging market needs. You'll get the opportunity to work with an elite team that goes beyond the usual analysis, they dig deeper knowing our goal is nothing short of transforming health care. This is a challenging role that creates an opportunity to grow and develop while doing your life's best work.(sm)


Positions in this function are responsible for the setup and maintenance of MedSeries 4 Reimbursement module and ensure the integrity of net revenue.  


Primary Responsibilities:

  • Ensure appropriate government reimbursement, to include, but not limited to, variance and discrepancy analysis, yearly Medicare reimbursement factors review, Medicare Disproportionate Share reimbursement, Medicaid supplemental payments, as well as also other government payment methodologies that have reimbursement implications
  • Code and maintain Managed Care contracts in Med Series 4 _Reimbursement model including the maintenance and update of CPT/ASC/APC/RVU/CMG /IFP/DRG tables, and AR/Case Mix description file, 
  • Development and execution of validation plans for coded contract
  • Development and production of managed care scorecards to demonstration validation and payment accuracy
  • Development and production of Payer Scorecard include but limit to A/R, payment and denial trends
  • Hold JOC (Join Operating Committee) with payers to resolve denial trends and/or billing issues to improve cash collection and reduce AR
  • EHR implementation – Build the reimbursement module from the ground up for facilities going through EHR transformation
  • Responsibilities include but not limited to payer and plan code table crosswalk from legacy system to EHR standard, build of carrier and plan code, code reimbursement for both government and managed care payers, set up the initial CPT/ASC/APC /RVU/CMG/FP/DRG tables and AR/Case Mix description file 
  • Perform month end reimbursement review on high dollars account with CFOs and Finance, as part of month close process
  • Perform reviews, research and other duties independently or as requested by the Senior Director, VP, CFO and Clients
  • Development and execution of reimbursement related test plans for each system up-grade. Collaborate with IT department to fix any issue that causes error in reimbursement calculation
  • Coordinate with other departments with process improvement project

Job Business Analysis
Other Location 
Organization O360 Dignity Health Back Ops
Schedule Full-time
Number of Openings 1
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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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