Policy Research Consultant- Remote
UnitedHealth Group
- Eden Prairie, MN
- $70,200-137,800 per year
- Permanent
- Full-time
- Research and identify industry guideline support for new medical cost savings initiatives across Medicare, Medicaid, and Commercial lines of business
- Partner with data team and conduct claims data analysis to determine viability of new reimbursement policy opportunities
- Collaborate with internal and external cross-functional teams to assess risk and gain alignment on new / enhanced policy direction and development
- Thoroughly and accurately evaluate and package reimbursement policy affordability concepts for clients to ensure acceleration, prioritization, quality, and successful approval and implementation
- Contribute policy thought leadership and research on Payment Integrity strategic initiatives and programs as needed
- Mitigate issues / risks on policy concepts and escalate with leadership as appropriate
- CPC, COC (formerly CPC-H), CIC, or CCA certification
- 2+ years of experience billing, coding, and/or auditing healthcare claims
- 2+ years of experience researching Medicaid and other state regulatory guidelines
- 2+ years of experience researching payment integrity industry guidelines such as CMS, AMA/CPT, etc.
- Experience presenting, collaborating, and consulting with a variety of stakeholders/clients across functional areas
- Reimbursement policy development experience
- Proficiency with MS Outlook (including ability to create and modify meeting invitations)
- Proficiency with MS Excel (including ability to create spreadsheets, manipulate data, and create pivot tables)
- Proficiency with MS PowerPoint (ability to populate templates for professional looking client presentations)
- Facility reimbursement experience (includes coding certification in facility)
- Experience working in a matrix and highly adaptive environment handling tight deadlines
- Experience in healthcare industry (Medicare, Medicaid, Commercial) with deep exposure to Payment Integrity
- Experience managing multiple concurrent projects and meeting tight delivery timelines
- Demonstrated ability to establish credibility quickly with all levels of management
- Proven solid project management approach with excellent critical thinking and problem-solving skills
- Proven highly collaborative and consultative style
- Proven innovative thinker that works well in an ambiguous, growth environment