Job Description - TRICARE Claims Business Process Manager - San Antonio or Richardson, TX (313102)
Job Description
TRICARE Claims Business Process Manager - San Antonio or Richardson, TX-313102
Description
UnitedHealth Military & Veterans Services is part of the family of companies that make UnitedHealth Group one of the leaders across the US health care system.
We serve those who serve our nation, providing quality health care services to millions of military beneficiaries across the South.
Our commitment to helping people live healthier lives, and to continue the honor, satisfaction, and quality of the TRICARE military health benefit program is greater than ever. Our efforts complement the Military Health System to demonstrate the best blend of public and private health care solutions.
It's not just business as usual. It is one of our proudest endeavors.
If you're ready to help make health care work better for those who serve our nation. If you are smart, creative, and committed. If you want to make a difference consider being part of the elite team at UnitedHealth Military & Veterans Services.
This is an opportunity to share in something special; a chance for all of us to serve, to excel, and to know that we've made a difference for those families who have made our nation stronger.
TRICARE Claims Business Process Manager - San Antonio or Richardson, TX - REQ #313102
UnitedHealth Group has submitted a proposal in response to the TriCare Managed Care Support Contract Solicitation (also known as the "T-3 Solicitation"). TriCare is the health care program serving active duty service members, National Guard and Reserve members, retirees, their families, survivors and certain former spouses.
As a potential government contractor, this position requires U.S. citizenship and proof of favorable adjudication following submission of Department of Defense form SF85P.
Primary Responsibilities:
- Responsible for all claim and provider reimbursement policy, interpretation, and requirements, audit, and testing, documentation and process improvement activities, reporting and analytics associated with claims processes reimbursement results.
- Management of the benefits and pricing configuration to ensure adjudication system correctness and payment accuracy
- Develop, adjust, support, and maintain accurate reimbursement for the claim operation that will encompass oversight and/or coordination with customer services, network, and meeting all government SLAs and operational requirements.
- Management and expansion of adjudication edit tools: such as COSMOS and the facility editor including implementation of reimbursement policies (national coding standard adoption), recommending and implementing payment policies to assure accurate adjudication of claims received and identification of invalid billing by providers, and identification of additional tools to identify billing inaccuracies and resulting claim overpayments
- Providing leadership in the development of payment trend reporting: by category of service, by specialty, etc. to identify inaccurate payment of claims or inappropriate payment of claims
- Identification is the start of the process but involves development of a root cause identification process with implementation of a resolution to the inaccurate payment processes
- Project management, staff development, development of policies and procedures as well as interfacing with government Health Plan executives
This is an opportunity to share in something special; a chance for all of us to serve, to excel, and to know that we've made a difference for those families who have made our nation stronger.
Qualifications
Qualifications:
- BA/BS degree is highly preferred. MBA or other advanced degree and/or Academy for Healthcare Management designation preferred
- 5+ years Leadership or Supervisory experience required
- 2 years of network management experience with provider relations or claims is required
- MS Word, Excel, and PowerPoint proficiency required
- 2 years of experience configuring/testing system and business process solutions is required
- COSMOS experience is preferred
- Demonstrated ability to build and maintain credibility with senior executives, vendors, customers and team
- Demonstrated ability to build and maintain high performing teams and managed multi-functional organizational structure
- Demonstrated focus on overall customer experience and ensure high quality of service
- Demonstrated ability to present information to a variety of audiences
- Demonstrated financial and analytical skills; with experience in managing cost statements, readily identify drivers of lower-than-expected performance, and proactively seek performance improvements to meet necessary cost and customer service performance metrics
- Demonstrated track record of continuous process improvement methodologies and application to claims environment
- Experience in Government contracting preferred
- Sets team direction, resolves problems and provides guidance to members of own team
- May oversee work activities of other supervisors
- Adapts departmental plans and priorities to address business and operational challenges
- Influences or provides input to forecasting and planning activities
- Product, service or process decisions are most likely to impact multiple groups of employees and/or customers (internal or external)
- Undergraduate degree or equivalent experience
Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.
Job Claim Business Process
Primary LocationUS-TX-San Antonio
Other LocationsUS-TX-Richardson
Organization Military & Veterans Hlth Srvcs
Schedule Full-time
Number of Openings 1
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