Provider Data Consultant - Remote - 2169298I

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Job Code
2169298I
At UnitedHealthcare, were simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us and start doing your life's best work.(sm)
This is a mission-critical position that's all about leveraging your knowledge, experience, and analytical skills to improve data accuracy for our network partners and providers. In this role, you will not only ensure provider data is maintained consistently and manage critical/complex data escalations to resolution, but also through this work, positively impact provider experiences and member outcomes. We're achieving higher levels of service in how provider data is managed and performs in our systems - join us and you'll play a key role in helping healthcare professionals focus on taking care of patients instead of insurance administration. This role will put you on a team of incredibly talented business professionals with the resources, backing, and opportunities you need to succeed.
Youll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:
Act as team SME responsible for coordinating team resources to ensure quality submission or load completion
Performs critical thinking analysis of each complex case submission including the reason for original request such as rework, terms in error, cred import errors utilizing SOPs, decision tree, knowledge central, market exception grid, etc., and makes required updates to database(s)
Direct loading of urgent demographic and contractual cases to ensure expedited results for the providers in markets supported
Monitor team reporting to ensure proper logging and execution of each actionable step of the process in IMPACT, continuously tracking submission requests through final audit and successful completion of the ask end to end
Monitors the management of all clarifications for the entire region regardless of submission origination to ensure quality completion of the ask
Assists with inventory management of cases submitted
Oversees audit results and provides feedback to management with a recommendation to reduce errors and improve processes and performance in collaboration with the team, management, and PDO
Assesses large data set project requests for appropriate team assignment for BAPA automation and submission assignments
Monitors direct loading of urgent demographic and contractual project cases to ensure expedited results for the providers in markets supported
Anticipate customer needs and proactively develop solutions to meet them
Serve as a key resource on complex and/or critical issues
Solve complex problems and develop innovative solutions
Perform complex conceptual analyses
Review work performed by others and provides recommendations for improvement
Assist in the forecast and planning resource requirements
Authorize deviations from standards
Lead functional or segment teams or projects
Provide explanations and information to others on the most complex issues
Motivate and inspire other team members
Coordinates and facilitates requirements gathering, identification of configuration needs, creation of cross-functional loading guidelines, and creation of implementation artifacts
Mentors and trains new and junior team members
Leads and attends meetings as subject matter expert and/or in support of leadership
Youll 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:
Undergraduate degree and/or 5 years of equivalent experience
Expert proficiency in NDB provider data loading for delegated and non-delegated providers
Expert proficiency with Excel, including use of filter, remove duplicates, text to columns, and basic formulas, etc.
Expert proficiency with all UHC provider data systems (NDB, CLM) and claims platforms (UNET, PULSE, NICE, COSMOS, CSP Facets) used in the region
Expert proficiency with multiple auditing tools, such as Examiner, Hive, NDAR, AMAARDI reporting
Advanced level of proficiency with all physician contract reimbursement methodologies
Solid knowledge of business processes that impact physician contact loading and auditing
Proven exceptional skills in manipulating data, attention to detail, strong organizational skills
Proven advanced analytical and problem-solving skills
Proven excellent written and verbal communication skills, including the ability to communicate at all levels including senior leadership and provider groups
Essential Competencies and Critical CLL Practices for High Performers
Competency: Communication and Collaboration
Behavioral Anchors:
Respond timely to emails or inquiries, within 48 hours if possible, and check to ensure the message was successful and effective
Plan and organize all communication and be mindful to follow proper escalation channels of communication
Leverage your talents and expertise and the talent and expertise of others to arrive at the best solution
Participate in meetings and share knowledge, suggestions and best practices
Keep Leadership and Business Partners updated on any roadblock or challenge
Look for opportunities to collaborate and build networks and relationships before they are needed
Send internal clarifications to Network Account Managers and/or Provider Advocates only when necessary and respond timely and effectively to any clarification request sent to you
Competency: Inventory and Time Management
Behavioral anchors:
Keep distractions at a minimum and ensure all work items are processed and prioritized efficiently and timely to guarantee metrics and turnaround times are met
Utilize all available resources and critical thinking skills to do your job before requesting assistance from others
Monitor and evaluate all available resource use and make any needed adjustments
Show commitment to high quality results through use of time, resources and work effort
Be thorough and action oriented in pursuing quality results by collaborating with others and by working across departmental boundaries
Demonstrate understanding of applicable products and contract terms for different lines of business (e.g., Employer and Individual, Medicare and Retirement, Community and State)
Provide timely review of all work items when needed
Offer assistance to team members if inventory increases or in order to accomplish more in less time
Competency: Leading Myself
Behavioral anchors:
Be accountable for yourself, your work and your own interactions
Be able to dig deeply and evaluate information to uncover the root cause of an issue in order to take decisive action
Pursue opportunities to become more self-aware
Seek feedback and address feedback positively, using it to enrich your knowledge and future effectiveness
Conduct yourself in a positive manner and demonstrate energy for what needs to be done to overcome challenges
Demonstrate diversity awareness
Stick to tasks and keep others informed of your progress
Use available resources designed for the task at hand in order to get work done timely, efficiently and effectively
Show compassion to improve customer experiences
Deploy your best self to achieve goals and objectives and to avoid distractions to remain focused
Be flexible and adaptive when faced with change
Ensure the required Learning and Educational Courses are completed in a timely manner
Ensure timely and accurate entry of all time worked
Achieve a sustainable work-life balance
Critical CLL Practice: Be Accountable
Be positive and show energy for what needs to be done and for overcoming obstacles and challenges
Organize work tasks according to business priorities
Be able to minimize distractions and maintain focus
Act on priorities and stick to tasks
Know the turnaround time for specific work tasks
Keep others informed of progress
Critical CLL Practice: Communicating With Others
Know the importance of keeping people informed
Plan and organize messages and communication
Separate the nice to know from the must know
Get your message across timely, effectively and efficiently
Ensure your message was successful
Critical CLL Practice: Collaborating
Look for opportunities to engage with others
Build networks and working relationships before they are needed
Understand that successful collaboration involves equitable give and take
Be dependable and respond to others promptly
Check in with others frequently to assure open channels of communication
Critical CLL Practice: Being Coachable
Be open and positive to feedback and use it constructively
Check often to ensure success and understanding with feedback
Be calm and appreciative when being coached
Critical CLL Practice: Delivering Results
Be committed to high quality results through efficient use of time, resources and work effort
Deliver and surpass customer expectations
Collaborate with others and work across departmental boundaries
Monitor and measure progress on accomplishing high quality results
Push yourself and others to be thorough and action oriented in pursuing high quality results
Careers with UnitedHealthcare.
Work with a Fortune 5 organization thats serving millions of people as we transform health care with bold ideas. Bring your energy for driving change for the better. Help us improve health access and outcomes for everyone, as we work to advance health equity, connecting people with the care they need to feel their best. As an industry leader, our commitment to improving lives is second to none.
California, Colorado, Connecticut, Nevada, New Jersey, New York, Rhode Island, or Washington Residents Only:
The salary range for California, Colorado, Connecticut, Nevada, New Jersey, New York, Rhode Island or Washington residents is $67,800 to $133,100. Pay is based on several factors including but not limited to education, work experience, certifications, etc. 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, youll find a far-reaching choice of benefits and incentives.
*All employees working remotely will be required to adhere to UnitedHealth Groups Telecommuter Policy
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyoneof every race, gender, sexuality, age, location and incomedeserves 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.
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Posted:
2023-06-01
Expires:
2023-07-01
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