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HCPCS - Manager
(Jobs in Minneapolis, MN)
Requirement id 75207
Job title Manager
Job location in Minneapolis, MN
Skills required HCPCS, Critical Thinking, -,
Open Date 08-Nov-2018
Close Date
Job type Contract
Duration 2 Months
Compensation DOE
Status requirement ---
Job interview type ---
   Email Recruiter: coolsoft
Job Description Manager: HCPCS, Critical Thinking, -,

Job Description :


Senior Consultant, Durable Medical Equipment Benefit Manager
(100% Remote, USA) - Contractor
Potential for up to 20% domestic travel
Optum Medical Benefit Management

Heres the thing about challenges. They provide limitless opportunities for greatness. And what we have in mind for you is definitely big. At UnitedHealth Group, were changing the future of health care and we have the expertise, advanced technology and global resources to make it happen.

Within OptumHealths Medical Benefit Management Group, we launch new products that improve the healthcare system for everyone. Focusing on innovation, clinical quality and value, we seek to improve the efficiency and effectiveness for our payer customers, their members and the physician who serve them.

This position is responsible for supporting the development of a management program for durable medical equipment, prosthetics, orthotics and supplies (DMEPOS). The individual in this role should bring deep knowledge of the durable medical equipment, prosthetic, orthotic and supply industry. Previous experience within a DMEPOS supplier, performing utilization management reviews of DMEPOS, or managing a DMEPOS ancillary network for a payer are ideal. Experience in multiple of those roles is preferred. The individual should also have a drive to innovate and be comfortable tackling thorny challenges in the healthcare space with a new approach. In addition to deep subject matter expertise, this individual needs to be comfortable having a perspective on what good looks like in managing outpatient DMEPOS.

Responsibilities will serving as subject matter expert for DMEPOS for multiple cross functional teams executing on the program. Necessary expertise includes:
* being familiar with CMS guidelines, NCDs, LCDs, and appropriate guidelines (InterQual, Milliman and Robbins) used in medical necessity determinations;
* fluency with understanding and logically breaking down DMEPOS benefit design for individuals less familiar with it
* familiarity with manufacturers and distributors in the outpatient DMEPOS space
* familiarity with billing procedures for DMEPOS

You will participate in or lead workstreams in partnership with some of or all of the following cross-functional teams:
* technology teams, to design supporting IT to meet needs of users;
* healthcare economic and finance teams, to predict and evaluate value delivered
* network contracting, to support contract design, network design, and as needed supplier negotiations
* operations, to help streamline and simplify job aids, design operational workflows, design staffing for all job functions
* medical policy and clinical teams, to jointly design best-in-class reimbursement policy and medical policy guidance
* sales and growth teams, to craft value stories for individual payer clients and join client sales conversations

This individual will report to the DMEPOS Product Director. This role has the potential to result in a full-time offer of employment.

Minimum Experience Required
* Knowledge of applicable state and federal laws, URAC and NCQA standards.
* HCPCS Codes as well as familiarity with Durable Medical Equipment
* Functional knowledge of managed care/insurance industry standard practices, e.g. provider billing practices, claims payments, prior authorization/utilization management criteria, etc.
* Experience with various insurance products including Managed Care, Medicare Advantage, Medicare and Medicaid desired
* Functional knowledge of health plan contract language, certificates of coverage, schedule of benefits, etc.
* Ability to navigate multiple platforms that contain provider data, member information, and authorizations.

Required Skills
* Critical thinking
* Ability or experience working ac
Call 502-379-4456 Ext 100 for more details. Please provide Requirement id: 75207 while calling.
Other jobs in MN: Coon Rapids (2), Duluth (6), Eagan (1), Edina (3), Little Falls (1), Maplewood (4), Mineapolis (1), Minneapolis (69), Minnesota (1), North Saint Paul (1), Plymouth (1), Roseville (2), Saint Cloud (3), Saint Paul (41), St Cloud (1), St Paul (5), Unknown (1),
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Description :

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(Manager: HCPCS, Critical Thinking, -, in Minneapolis, MN)
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