Sr. Compliance Product Manager, Medicaid and Medicare Dental

UnitedHealthcare is a company that’s on the rise. We’re expanding in multiple directions, across borders and, most of all, in the way we think. Here, innovation isn’t about another gadget, it’s about transforming the health care industry. Ready to make a difference? Make yourself at home with us and start doing your life’s best work.(sm)

You’ll enjoy the flexibility to telecommute* from anywhere within United States as you take on some tough challenges.

Primary Responsibilities:

* Serves as the dental Medicare product SME, understands the claims administrations systems requirement and identifies system changes needed. Work with implementation developers and monitor outcomes for change requests

* Represents dental Medicare with internal partners – QuEST and M&R Compliance
* Service as operational implementation business lead for new or changing regulations with teams
* Responsible for monthly internal QuEST monitoring to ensure Medicare program is being managed according to customer expectations and quarterly M&R ODAG universe reporting
* Responsible for changes to the ODAG universe based on client requirements
* Serve as primary functional liaison to UHC regulatory resources to ensure regulatory requirements and systems change projects are incorporated into project pipelines
* Develop opportunities to better align Medicare support for all of dental including private label Medicare support and reporting requirements
* Acts as a functional owner in applying contract terms or changing regulations for the Facets and Skygen platforms with project oversight for remediation efforts and change management
* Support implementation projects and serve as SME/consultant for regulatory requirements and process implementation
* Consult in the development of policies and procedures and workflow guidelines for process and regulatory adherence
* Coordinate and perform UAT for key systems and reporting change/upgrade processes
* Coordinate, represent and participate in CMS, OIG, Medicaid & Medicare Audits for the Dental organization
* Support and execute compliance projects
* Support FACETS system configuration oversite: TB499 table, BPL, Eligibility Mapping, CMS and EOB Tables, ELGS, CEOB, IDN letter, eCFI and Print Trail projects
* Establish and Maintain Vendor/Process Quality Oversite and Audit programs
* Develop audit reports/data universes and processes for monitoring key functional areas (claims, prior auths, call)
* Review sample data/process elements for compliance with regulatory and contract provisions
* Formalized work with Account Managers and Implementation Managers to review UAT of product/benefit change projects or regulatory compliance
* Review audit reports/data universes and processes for monitoring key functional areas (claims, prior auths, reports, etc.) and ensure contract compliance
* Reporting Oversight and Consultation
* Consultation on business rules for CMS reporting (Medicare CMS reporting): Analysis, requirements review/mapping, change management, QA/UAT of reporting output
* Document and define processes and control standards for various universe reporting projects (Medicare/CMS, Medicaid)
* Catalog reporting to ensure compliance with contract requirements

Functional Competencies:

* Analyze RFP/contract language with respect to regulatory requirements and incorporate requirements into project plans

* Assist internal and/or external business partners with completion of tasks and resolution of issues and problems with program
* implementation
* Establish and/or implement internal and/or external service level agreements in order to ensure ability to monitor and measure program performance (e.g., turnaround time; quality; effectiveness)
* Review, create, and/or maintain workflows to ensure they are up-to-date and operationally efficient
* Provide guidance, expertise, and/or assistance to internal and/or external partners (e.g., claims; call center; benefits; clinical) to ensure programs and strategies are implemented and maintained effectively
* Communicate with and help internal and/or external partners interpret contractual requirements in order to ensure effective problem solution and strategy implementation
* Demonstrate understanding of and adhere to relevant policies, procedures, and regulations
* Stay abreast of changes and/or updates in relevant policies, procedures, and regulations
* Serves as a key resource on complex and/or critical regulatory issues
* Performs business analyses on benefit and regulatory change requirements
* Participate in the definition of project roles to drive the gathering of detailed business, functional and non-functional requirements
* Gather information needed for the definition of requirements (e.g., business use cases, user stories)
* Develop business context diagrams (e.g., business data flows, process flows) to analyze/confirm the definition of project requirements

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:

* Bachelor’s degree or equivalent work experience

* 5+ years of Product Management, Business Analysis, or Project Management experience
* 2+ years of experience working with vendor relationships
* 2+ years of experience in claims systems analysis, configuration, or process work
* Experience with Medicaid and/or Medicare Compliance
* Experience managing projects involving operational initiatives
* Operations experience within a matrix organization
* Experience leading matrix organizational projects/initiatives, preferably in a healthcare insurance or provider environment
* Advanced Excel skills (Expertise with manipulating data, Pivot tables, Macros, advanced analysis features)
* Ability to work with reporting systems such as Business Objects, and produce basic reports or extracts of data
* If you need to enter a work site for any reason, you will be required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or similar UnitedHealth Group-approved symptom screener. When in a UnitedHealth Group building, employees are required to wear a mask in common areas. In addition, employees must comply with any state and local masking orders

Preferred Qualifications:

* Healthcare administration or healthcare benefits administration experience

* Experience with Dental
* Intermediate experience with reporting and analysis tools including Excel, other reporting and database query software tools such as Access or SQL
* Ability to quickly build strong meaningful relationships both internally and externally
* Experience in the healthcare industry
* Ability to prioritize and handle large volumes of operational tasks and projects simultaneously
* Ability to communicate complex information tailored specifically to the audience so that it is easily understood

Careers at UnitedHealthcare Employer & Individual. We all want to make a difference with the work we do. Sometimes we’re presented with an opportunity to make a difference on a scale we couldn’t imagine. Here, you get that opportunity every day. As a member of one of our elite teams, you’ll provide the ideas and solutions that help nearly 25 million customers live healthier lives. You’ll help write the next chapter in the history of health care. And you’ll find a wealth of open doors and career paths that will take you as far as you want to go. Go further. This is your life’s best work.(sm)

Colorado Residents Only: The salary range for Colorado residents is $79,700 to $142,600. Pay is based on several factors including but not limited to education, work experience, certifications, etc. As of the date of this posting, In addition to your salary, UHG offers the following benefits for this position, subject to applicable eligibility requirements: Health, dental, and vision plans; wellness program; flexible spending accounts; paid parking or public transportation costs; 401(k) retirement plan; employee stock purchase plan; life insurance, short-term disability insurance, and long-term disability insurance; business travel accident insurance; Employee Assistance Program; PTO; and employee-paid critical illness and accident insurance.

* All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy

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: Sr. Compliance Product Manager, Compliance Product Manager, Compliance, Product Manager, Medicaid, Medicare, Dental, Product Management, Business Analysis, Project Management, Telecommute, Telecommuting, Telecommuter, Work From Home, Work At Home, Remote


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