Medicaid Contract Specialist - National Remote

Optum Home & Community Care, part of the Optum family of businesses, is creating something new in health care. We are uniting industry-leading solutions to build an integrated care model that holistically addresses an individual’s physical, mental and social needs — helping patients access and navigate care anytime and anywhere. As a team member of our Senior Community Care (SCC) team, we work to provide care to patients at home, nursing homes and assisted living for senior housing. This life-changing work adds a layer of support to improve access to care. We’re connecting care to create a seamless health journey for patients across settings. Join us to start Caring. Connecting. Growing together.

The Medicaid Contract Specialist is responsible for managing administrative tasks aligned with the Skilled Nursing Facility contracting process, as well as providing internal support. The Medicaid Contract Specialist will create contracts, support critical reviews to ensure demographic, credentialing and contract accuracy prior to submission. The Medicaid Contract Specialist will play an active role through the load and audit process with all applicable contract loading teams, as well as be accountable to review audit results post-installation. The Medicaid Contract Specialist will also be accountable to manage and submit all daily and mass State Rate updates to all applicable contract loading teams on behalf of Network Management.

This position is full-time, Monday - Friday. Employees are required to work our normal business hours of 6:00am – 5:00pm CST. It may be necessary, given the business need, to work occasional overtime.

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

Primary Responsibilities:

• Build and maintain relationships with Optum Network Management, Health Plan and contract loading teams to ensure accurate contract set up results are obtained and maintained
• Manage Skilled Nursing Facility (SNF) contracts, including validation of demographics, credentialing, and system accuracy prior to installation in applicable systems
• Coordinate with quality audit team both pre- and post-implementation to ensure accuracy of contract loading and claim payment accuracy based on contract intent
• Minimize contracting and claim rework associated with incorrect SNF contract set up
• Experience with Medicare, Commercial, and Medicaid will be of value in this role
• Any other projects or duties as assigned
• Use pertinent data and facts to identify and solve a range of problems within area of expertise
• Prioritize and organize own work to meet deadlines
• Be a key resource for addressing questions regarding contract language, contract set-up, payment methodology and other processes
• Attention to detail, problem solving, and establishing and maintaining solid business relationships are crucial for success in this role  

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 may be interested in. 
 

Required Qualifications:  

• High School Diploma / GED (or higher) OR equivalent work experience
• 3+ years of experience in a network data management related role in a managed care environment, such as contract loading or provider data analysis
• Experience using NDB, Cosmos, CSP Facets and Emptoris
• Intermediate proficiency with MS Office suite, including Word and Excel
• Ability to work any of our 8-hour shift schedules within our normal business hours of 6:00am – 5:00pm CST
   

Preferred Qualifications:  

• 2+ years of experience working with reporting tools and generating effective reports
• 2+ years of experience with claims processing, resolution, or recovery
• Experience with facility claims processing systems and guidelines
• Medicaid, Medicare and Commercial product knowledge
   

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you’ll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $28.94 to $51.63 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.