UnitedHealth Group Manager of Submissions - WellMed - San Antonio, TX in San Antonio, Texas
The Manager of Submissions, Risk Adjustment, supervises, directs, plans, and organizes the processes that drive the collection, submission, deletion and reporting of data required by the Centers for Medicare and Medicaid Services (CMS).
This position consults on the development, specification and integration of WellMed’s Risk Adjustment Submissions and Reconciliation systems and will analyze business needs, document requirements, translate needs into functional and / or technical specifications, write and execute test cases and plans, and oversee testing processes.
This position will oversee day-to-day operations of WellMed’s Risk Adjustment Submissions and Reconciliation processes. Primary Responsibilities: Develops policies and procedures for system, application and related operational processes in order to ensure optimization and compliance with established standards and regulations internally at WellMed and externally with CMS or other regulating body Provides short range trouble shooting for day-to-day issues and ongoing maintenance with Risk Adjustment Submissions and Reconciliation applications and reporting Makes recommendations as needed to ensure reliability of the systems and finds innovative solutions if problems should occur Ensures that the risk adjustment diagnostic submissions to CMS and/or health plans or their intermediary occur timely and accurately; this includes additions and deletions where appropriate Provides claims/encounter data reconciliation between CMS and/or health plans or intermediary with business claims and coding detail to ensure accurate risk adjustment payments on behalf of provider groups Defines project scope and objectives based on business needs combined with a thorough understanding of enterprise business systems and industry requirements Performs a major role in the development and implementation of major systems. This role may interface with multiple business units such as accounting / finance, claims, operations, physician clinics, customer service, executive management, and sales and marketing Serves as an expert resource regarding the alignment of enterprise system strategies with the business goals and strategic drivers Applies knowledge of managed care operating environment and underlying systems data to all major production systems used for delivery of services to internal and external clients Develops and maintains strong relationships with both internal/externals customers at the senior management and executive level in order to influence project teams and gain consensus on the selection of the most viable solutions.
The position acts as a key team member to both IT and the business Uses strong critical thinking skills along with managed care, or physician office business knowledge to have insight and understanding of business concepts, tools and processes that are needed for making sound decisions in the contact of the company’s business Tracks progress and notifies management of issues that require escalation, and assumes responsibility for resolving or coordinating the resolution of system and process issues Develops and maintains project plans, and manages specific tasks to ensure project success Collaborates on and oversees various projects as assigned that are cross-functional in nature Performs all other related duties as assigned Required Qualifications: Bachelor’s degree in Finance, Business, Computer Science, Information Systems or related technical field (4+ years of comparable work experience may be substituted in lieu of a bachelor’s degree) 10+ years of experience in developing requirements and performing system analysis 3+ years of experience leading technical projects or teams 2+ years of experience in Health Care Experience with various system development lifecycles such as waterfall, and Agile methods Working knowledge of Medicare Risk Adjustment and/or Medical Claims processing Preferred Qualifications: Advanced degree in a related discipline 3+ years of supervisory experience 5+ years of experience in one or more of the following areas: systems design, database programming experience, HL7 integration, X12 integration, EDI, practice management system implementation and support, EMR system implementation and support, Claim adjudication system implementation and support, Care Management system implementation and support Ability to communicate ideas and problem solutions Ability to effectively work with both internal and external clients Physical & Mental Requirements: Ability to lift up to 25 pounds Ability to push or pull heavy objects using Ability to sit for extended periods of time Ability to stand for extended periods of time Ability to use fine motor skills to operate office equipment and/or machinery Ability to properly drive and operate a company vehicle Ability to receive and comprehend instructions verbally and/or in writing Ability to use logical reasoning for simple and complex problem solving Careers with WellMed.
Our focus is simple.
We're innovators in preventative health care, striving to change the face of health care for seniors.
We're impacting 240,000+ lives, primarily Medicare eligible seniors in Texas and Florida, through primary and multi-specialty clinics, and contracted medical management services.
We've joined Optum, part of the UnitedHealth Group family of companies, and our mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness.
Our providers and staff are selected for their dedication and focus on preventative, proactive care.
For you, that means one incredible team and a singular opportunity to do your life's best work.(sm) 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. Job Keywords: Manager of Submissions, WellMed, Agile, San Antonio, TX, Texas 6b2218e0-a431-4067-8f28-8de26ba8d7d8
Manager of Submissions - WellMed - San Antonio, TX Texas-San Antonio 759392