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Payment Integrity & Policy Manager

Employer
UCare
Location
Minneapolis, Minnesota
Start date
Oct 6, 2023
Closing date
Dec 1, 2023

View more

Category
Healthcare
Employment Status
Full Time

Job Details

Health Care that Starts with You!

Join a truly mission-driven organization! Independent, nonprofit UCare is recognized as one of the Minnesota's leading health plans. We provide more than 600,000 members across Minnesota and western Wisconsin with the health coverage plans and services they need to maintain and improve their health. The innovative coverage we create makes a difference for Medicare-eligible individuals, individuals and families enrolled in Minnesota Health Care Programs, such as MinnesotaCare and Medical Assistance, and disabled adults with special health care needs.

UCare is growing in size, membership, products, geographic coverage, and employees. We're an organization that's going places. Be part of a team that cares about you, be part of UCare.

Rewards

Enter a highly collaborative environment where people are truly engaged, and feedback is valued. You'll enjoy a competitive salary and benefits, as well as a host of other perks, including a nationally recognized wellness program, and a bright, open, award-winning office space in Northeast Minneapolis just minutes from major freeways and retail centers.

At UCare, we welcome and employ a diverse employee group committed to meeting the needs of UCare, our members, and the communities we serve.

www.ucare.org/careers/

EOE/AA

ABOUT UCARE

UCare offers Medicare, Medicaid, Individual and Family health plans - powered by the hardest working people in the industry. Our people powered teams de-complicate, advocate and always go the extra mile to help our members. We serve with integrity, compassion and commitment to do right by members, providers and government partners. Above all, we come to work excited to provide members a path for the best health of their lives.

WORKING AT UCARE

Working at UCare is more than a career; it's a mission. A mission that defines us as professionals, unites us as an organization and shapes how we interact with our members and each other. Employees join UCare and stay because of the opportunity to have a purpose-driven job.

Our strong culture has established UCare as a Star Tribune Top 200 Workplace for 14 consecutive years since the awards program began. It's a culture that embraces innovative ideas, strategic partnerships, and exemplary customer and provider experiences. Working at UCare is being a part of a people powered team dedicated to making a real difference in the lives of our members and communities.

PAYMENT INTEGRITY & POLICY MANAGER

Work Location: Work from Home or Office for your Day

Position Description

This position is responsible to manage analytical support for providers relating to payment methodology and claims adjudication payment rates, developing and analyzing fee schedules utilized for claims adjudication, maintaining a process to analyze the impact of claims adjudication fee schedule changes, producing claims settlement analysis outside of the core processing system, monitoring market claims adjudication trends, collaborating with Configuration & Claims Operations teams relating to claims processed through third party vendor groupers and pricers for claims adjudication on current and potential new vendor solutions, managing of UCare's Payment Policy initiatives.

• Manage the process to create, analyze, maintain, and document the fee schedules used for claims adjudication.

• Manage analytical support and communications with providers relating to UCare's payment methodology and rate development.

• Facilitate the Payment Policy Workgroup and manage the implementation, documentation of new payment policies, and maintaining existing policies related to UCare's Payment Policy initiatives.

• Manage inquiries and pricing components relating to services processed through third party vendor groupers and pricers.

• Review and distribute inquiries relating to rates and reimbursement methodology via the internal compliance software.

• Review and distribute payment policy/adjudication rate inquiries submitted via the Payment Policy Project Board

• Develop and maintain positive working relationships with internal and external customers.

• Manage, select, train, develop and evaluate staff. Monitor workflow and provide performance feedback. Build and maintain a team of highly effective analysts responsible for reporting and analytical support for internal and external customers.

• Other projects and duties as assigned.

Education

BS/BA with and emphasis in finance/accounting or related field; demonstrated experience may be considered in lieu of degree.

Required Experience

Five years related experience in pricing or provider payment methodology experience. Intermediate skills with Excel.

Preferred Experience

Knowledge of the Managed Care industry and SQL skills.

THE UCARE DIFFERENCE

The UCare difference is our people power - employees actively working on the behalf of our members to get them access to the health care they need. We value and respect each individual's ideas and contributions, and provide the freedom to grow both personally and professionally. We are centrally located, and offer onsite education, equipment and wellness resources, and a myriad of volunteer activities. If you're looking for an inclusive environment that celebrates your people power, helps you build on your strengths and gives you the opportunity to truly make a difference, we invite you to apply.

As an Equal Opportunity/Affirmative Action Employer, we welcome and employ a diverse employee group committed to meeting the needs of UCare, our members, and the communities we serve.

JOB POST DATE: 10/5/2023

Company

UCare offers Medicare, Medicaid, Individual and Family health plans – powered by the hardest working people in the industry. Our people powered teams de-complicate, advocate and always go the extra mile to help our members. We serve with integrity, compassion and commitment to do right by members, providers and government partners. Above all, we come to work excited to provide members a path for the best health of their lives. 

WORKING AT UCARE

Working at UCare is more than a career; it's a mission. A mission that defines us as professionals, unites us as an organization and shapes how we interact with our members and each other. Employees join UCare and stay because of the opportunity to have a purpose-driven job. 

Our strong culture has established UCare as a Star Tribune Top Workplace for 12 consecutive years since the awards program began. It’s a culture that embraces innovative ideas, strategic partnerships, and exemplary customer and provider experiences. Working at UCare is being a part of a people powered team dedicated to making a real difference in the lives of our members and communities. 

THE UCARE DIFFERENCE

The UCare difference is our people power – employees actively working on the behalf of our members to get them access to the health care they need. We value and respect each individual's ideas and contributions, and provide the freedom to grow both personally and professionally. We are centrally located, and offer onsite education, equipment and wellness resources, and a myriad of volunteer activities. If you're looking for an inclusive environment that celebrates your people power, helps you build on your strengths and gives you the opportunity to truly make a difference, we invite you to apply.  

Company info
Website
Telephone
612-676-6500
Location
500 Stinson Blvd.
Minneapolis
Minnesota
55413
United States

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