Bring us your experience, your head for strategy, your strength with relationships and your eye for opportunity. In return we offer an unmatched place to grow and develop your career among a richly diverse group of businesses driven by the power and stability of a leading health care organization. Come help us heal and strengthen the health care system as you do your life's best work.(sm) Primary Responsibilities:Conducting research and preparing for NYS Fair Hearings, including but not limited to: conducting a timeline review of events, collecting evidence, preparing an evidenciary packet, and drafting a written submission for the Fair HearingNarrate a story both verbally and in a clear and concise written formatPersonally attend hearings and present the Plan's position to an Administrative Law Judge (ALJ) at the hearing offices in downtown Brooklyn, attend hearings via telephone for the rest of NYS, and support the team in complying with Fair Hearing decisionAnalyzes and investigateProvides explanations and interpretations within area of expertisePerform data analyses, manipulation and comparisonsProvide product and / or regulatory training to clients and business partnersTriage reimbursement and product issues from clients and business partners
Required Qualifications:Bachelor's degree or equivalent work experience 2+ years of experience in a health care regulatory environment (managed care, and / or compliance expertise preferred) 1+ years of experience with understanding of personal care services, skilled nursing facilities, claims payment and/or reimbursement, and pharmacy claims related issues Strong problem solving and analytical skills Exceptional interpersonal and negotiation skills Strong verbal and written communication skillsPreferred Qualifications:Exposure to Fair HearingsSystem knowledge with any of the following: Facets, eMedNy, Care1/IQ, ECAACareers at UnitedHealthcare Community & State. Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. We serve the health care needs of low income adults and children with debilitating illnesses such as cardiovascular disease, diabetes, HIV / AIDS and high-risk pregnancy. Our holistic, outcomes-based approach considers social, behavioral, economic, physical and environmental factors. Join us. Work with proactive health care, community and government partners to heal health care and create positive change for those who need it most. This is the place 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: Managed Care, Compliance, Claims, reimbursement, regulatory, Facets, eMedNy, Care1/IQ, ECAA, New York City, NY, New York,
Our mission is to help people live healthier lives and to help make the health system work better for everyone.- We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities. - We work with health care professionals and other key partners to expand access to quality health care so people get the care they need... at an affordable price. - We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions.