Pricing Capability Manager – Telecommute

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that is improving the lives of millions. Here, innovation is not about another gadget; it is about making health care data available wherever and whenever people need it, safely and reliably. There is no room for error. If you are looking for a better place to use your passion and your desire to drive change, this is the place to be. It’s an opportunity to do your life’s best work.(sm)

As the Pricing Capability Manager, you will be vital to our success and drive quality improvements and operating efficiency for Provider Configuration. You will join a team of Operations leaders and play a vital role in ensuring we consistently meet and exceed market expectations.

You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Serve as primary Pricing Technical SME to critically assess CMS, State and Provider contracts to ensure Facets/NetworX system capability can meet pricing requirements; and recommend solutions to minimize manual processes to address system limitations
• Collaborate with Pricing Configuration to identify and define quality improvement requirements to ensure flawless pricing execution
• Promote understanding of provider reimbursement and system architecture to drive cross functional team collaboration
• Gather technical requirements and participate in the documentation of business requirements to create automated solutions and control reports to monitor and improve standards in pricing operations
• Act as escalate lead for identified provider pricing opportunities and risks; work with operational areas to develop and execute risk mitigation plans
• Participate in new market implementation and system conversions to provide business feedback and requirements
• Perform user acceptance testing and operational readiness for all new programs and program enhancements, ensuring all end-to-end operational impacts assessed, requirements defined, operations documentation completed (e.g., process flows, policies, and procedures), communications delivered, and ongoing operations support established
• Provide thought leadership in identifying and defining ongoing incremental opportunities
• Evaluate and continually improve processes to achieve goals that drive best in class pricing outcomes and financial results
• Prepare materials and present to leadership team

You’ll 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 be interested in.

Required Qualifications:

• Undergraduate degree or equivalent work experience
• 5+ years reading and interpreting physician/facility/ancillary contracts and their associated reimbursement methodologies
• 5+ years working with Medicare, Medicaid or Commercial products
• 3+ years Facets / NetworX Pricing experience, preferably in provider pricing configuration role
• Experience gathering and documenting business requirements, creating user stories, and developing workflows
• Experience executing SQL queries and analyzing reports
• Solid knowledge of business end-to-end processes that impact physician/facility/ancillary reimbursement, contract loading and/or auditing

Preferred Qualifications:

• Previous provider pricing delegation experience
• Experience with UHC Secondary Platforms (CSP Facets / COSMOS)
• Revenue Cycle Management experience

To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement result in rescission of an employment offer or termination of employment

Careers with Optum. Here’s the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world’s large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life’s best work.(sm)

Colorado, Connecticut or Nevada Residents Only: The salary range for Colorado residents is $82,100 to $146,900. The salary range for Connecticut / Nevada residents is $90,500 to $161,600. 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, you’ll find a far-reaching choice of benefits and incentives.

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

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.